This case series assesses the benefits of intracutaneous injection of botulinum toxin A (BTX-A) for the treatment of intractable pain of supraorbital postherpetic neuralgia (PHN) not responding to oral drug therapy. Three patients experiencing intractable pain of supraorbital PHN, which was not responding satisfactorily to oral pregabalin and oral amitriptyline therapy, were managed with the intracutaneous injection of BTX-A in the affected dermatomes. Postinjection during each visit at 2, 4, 6, 8, 10, and 16 weeks, the Numeric Rating Scale pain score of the patients was assessed (0: painless; 10: maximum pain). There was a significant reduction in the severity of pain after BTX-A injection, and subsequently, the oral medications were significantly reduced thereafter. Hence, BTX significantly decreases the severity of intractable pain in supraorbital PHN patients.

Persistent chronic pain is the most common residual complaint in cancer survivors; its etiology being neoplastic process, postcancer treatment, or any other concurrent disorders. Growing concern about pain management in cancer survivors throws a mammoth challenge because more than 40% of cancer survivors now live longer than 10 years. Due to limited studies on persistent chronic pain in cancer survivors other than breast cancer, this enormous challenge remains in pain management in these cancer survivors. There are innumerable predictive factors for the development of persistent pain after cancer surgeries. It would be more prudent to concentrate on chronic pain mechanisms despite holding on to categorial risk factors and implanting them into patient outcomes. An effort should be made to a more holistic management of nociceptive and neuropathic pain in cancer survivor patients of Head and Neck, Prostate, and Lung carcinoma patients. In this article, we have tried to review the literature on managing chronic persistent pain in all cancer survivors, excluding carcinoma of the breast. In conclusion, we would like to emphasize that for an improved or excellent outcome of chronic persistent pain in cancer survivors, a holistic, multimodal approach encompassing pain relief techniques and pain relief strategies, relaxation exercises, cognitive behavioral therapy, and neuro-rehabilitative strategies would prove to be of immense help. A joint understanding between the pain management expert and the cancer survivors can result in beneficial outcomes.

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