Subcutaneous and Perineural Botulinum Toxin Type A For Neuropathic Pain

Fabregat-Cid, Gustavo; Andrés, José De; Villanueva-Pérez, Vicente L.; Asensio-Samper, Juan Marcos

doi:10.1097/ajp.0b013e31827eafff

Cited by 30 publications

(22 citation statements)

References 35 publications

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“…[31,32] Its pain relief effect might be mediated through the sensory system. [27] The dosage of BTA previously used for treating neuropathic pain was between 2.5 and 7.5 U/cm 2 at each painful surface area with the maximum total dosage from 100 to 200 U.…”

Section: Discussionmentioning

confidence: 99%

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Li¹,

Lv²,

Li³

et al. 2017

Medicine

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Background:To assess the effect of botulinum toxin A (BTA) for treating neuropathic pain in patients with spinal cord injury (SCI).Methods:A total of 44 patients with SCI with neuropathic pain were randomly divided into the intervention group and the placebo group, each group 21 patients. The subjects in the intervention group received BTA (200 U subcutaneous injection, once daily) at the painful area, whereas those in the placebo group were administered a saline placebo. This study was conducted from December 2014 to November 2016. The primary outcome was measured using the visual analog scale (VAS). The secondary outcomes were measured using the short-form McGill Pain Questionnaire (SF-MPQ), and World Health Organization quality of life (WHOQOL-BREF) questionnaire. All outcome measurements were performed before and after 4 and 8 weeks of intervention.Results:Forty-one participants completed the study. The intervention with BTA showed greater efficacy than placebo in decreasing the VAS score after week 4 and week 8 of treatment. Significant differences in the SF-MPQ and WHOQOL-BREF were also found between the 2 groups.Conclusion:The results of this study demonstrated that BTA might decrease intractable neuropathic pain for patients with SCI.

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Section: Discussionmentioning

confidence: 99%

Retracted

Li¹,

Lv²,

Li³

et al. 2017

Medicine

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“…However, recent studies have reported that BTX‐A for the treatment of neuropathic pain can be administered subcutaneously or intradermally 9, 10, 11, 25, 26. The effects on pain may be mediated through direct effects on the sensory system 16.…”

Section: Discussionmentioning

confidence: 99%

“…In a previous case report of BTX for neuropathic pain in patients with spinal cord lesions, BTX‐A was administered subcutaneously; a subcutaneous route was chosen for this study 17. In most studies, the fractioned dosage of BTX‐A for the treatment of neuropathic pain was between 2.5 and 7.5U/cm 2 per painful surface area, and the maximum total dosage was between 100 and 200U 9, 10, 11, 25, 26, 27. In the present study, the painful surface area in patients with SCI was generally larger than that in patients with focal neuropathy such as postherpetic neuralgia and post‐traumatic neuropathy.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin type A for neuropathic pain in patients with spinal cord injury

Han

Song

et al. 2016

Annals of Neurology

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ObjectiveTo evaluate the analgesic effect of botulinum toxin type A (BTX‐A) on patients with spinal cord injury‐associated neuropathic pain.MethodsThe effect of BTX‐A on 40 patients with spinal cord injury‐associated neuropathic pain was investigated using a randomized, double‐blind, placebo‐controlled design. A 1‐time subcutaneous BTX‐A (200U) injection was administered to the painful area. Visual analogue scale (VAS) scores (0–100mm), the Korean version of the short‐form McGill Pain Questionnaire, and the World Health Organization WHOQOL‐BREF quality of life assessment were evaluated prior to treatment and at 4 and 8 weeks after the injection.ResultsAt 4 and 8 weeks after injection, the VAS score for pain was significantly reduced by 18.6 ± 16.8 and 21.3 ± 26.8, respectively, in the BTX‐A group, whereas it was reduced by 2.6 ± 14.6 and 0.3 ± 19.5, respectively, in the placebo group. The pain relief was associated with preservation of motor or sensory function below the neurological level of injury. Among the responders in the BTX‐A group, 55% and 45% reported pain relief of 20% or greater at 4 and 8 weeks, respectively, after the injection, whereas only 15% and 10% of the responders in the placebo group reported a similar level of pain relief. Improvements in the score for the physical health domain of the WHOQOL‐BREF in the BTX‐A group showed a marginal trend toward significance (p = 0.0521) at 4 weeks after the injection.InterpretationThese results indicate that BTX‐A may reduce intractable chronic neuropathic pain in patients with spinal cord injury. Ann Neurol 2016;79:569–578

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“…A cadeia leve vai exercer uma atividade proteolítica sobre o complexo SNARE, indispensável para a fusão de vesículas de acetilcolina com a membrana pré-sináptica. 4,18,16 A toxina, de acordo com seu sorotipo, vai quebrar uma ou outra proteína deste complexo (no caso da BTX-A a SNAP 25), e tem como consequência a inibição da translocação, exocitose e liberação de acetilcolina na fenda sináptica. 16,18 Inicialmente, acreditava-se que as propriedades analgésicas da BTX-A estavam associadas à diminuição da contração muscular e provavelmente associada a suas propriedades colinérgicas.…”

Section: Uso Da Toxina Botulínica Na Neuralgia Pós-herpéticaunclassified

“…24 Na maioria dos estudos, BTX-A foi administrada por via subcutânea ou intradérmica com doses fracionadas variando de 2,5 a 7,5 UI/ cm 2 na área dolorosa, não sendo ultrapassadas 200 UI no total. 3,18 Em teoria, a toxina botulínica tem potenciais vantagens quando comparada a analgésicos orais, seja por sua longa duração de ação (aproximadamente três meses), pela facilidade de ser administrada diretamente no ponto doloroso, por sua excelente tolerabilidade, seja por seu perfil de segurança e ausência de efeitos sistêmicos. 25 …”

Section: Técnica De Aplicaçãounclassified

Toxina botulínica: uma nova opção para o tratamento da neuralgia pós-herpética?

Talarico

2014

Revista Hospital Universitário Pedro Ernesto

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ResumoA dor neuropática pode ocorrer após injúria do sistema nervoso central ou periférico, gerando dor espontânea, alodínea e hiperalgesia. Uma das principais causas de dor neuropática é a neuralgia pós-herpética. Sua incidência aumenta em pacientes com idade mais avançada, o que dificulta ainda mais o tratamento, muitas vezes limitado por seus efeitos colaterais, principalmente cognitivos. A combinação de tratamentos é prática clínica comum e novas modalidades terapêuticas vêm sendo aplicadas para aliviar essa condição. A toxina botulínica tipo A tem sido usada para diversos quadros clínicos associados à hiperatividade muscular, como distonia cervical. Recentemente, foram propostos mecanismos analgésicos independentes da contração muscular, ainda pouco conhecidos.Descritores: Neuralgia; Neuralgia pós-herpética; Toxinas botulínicas tipo A. AbstractNeuropathic pain can occur after injury to the peripheral and/or central nervous system, resulting in spontaneous pain, allodynia and hyperalgesia. One of the main causes of neuropathic pain is post-herpetic neuralgia. It occurs increasingly with age and that makes the treatment even more complicated due to the limitation caused by cognitive adverse effects. Combining therapies with different mechanisms of action is usual in clinical practice and new procedures are considered to treat this condition. Botulinum toxin type A has been used to treat certain disorders related to muscle overactivity. Not well known analgesic mechanisms have been proposed recently, independent of the muscle contraction.Keywords: Neuralgia; Neuralgia, postherpetic; Botulinum toxins, type A. ResumenEl dolor neuropático puede darse después del daño al sistema nervioso central o periférico, provocando dolor espontáneo alodinia y hiperalgesia. Una de las principales causas del dolor neuropático es la neuralgia postherpética. Su incidencia aumenta en pacientes de edad avanzada, lo que dificulta todavía más el tratamiento, muchas veces limitado por sus efectos colaterales, principalmente cognitivos. La combinación de tratamientos es práctica clínica común y se vienen aplicando nuevas modalidades terapeúticas para aliviar esta situación. La toxina botulínica tipo A ha sido usada en diversos cuadros clínicos asociados a la hiperactividad muscular, como distonía cervical. Recientemente, fueron propuestos mecanismos analgésicos independientes de la contracción muscular, todavía poco conocidos.Palabras clave: Neuralgia; Neuralgia posherpética; Toxinas botulínicas tipo A.* Endereço para correspondência: Rua Maestro Francisco Braga, 175, ap. 101 Rio de Janeiro, RJ, Brasil. CEP: 22041-070.

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Subcutaneous and Perineural Botulinum Toxin Type A For Neuropathic Pain

Abstract: On the basis of the analysis of the reports published in the literature, it would seem that fractioned peripheral subcutaneous and perineural injections of botulinum toxin type A may be useful for the treatment of various chronic pain conditions with neuropathic component.

Cited by 30 publications

References 35 publications

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Botulinum toxin type A for neuropathic pain in patients with spinal cord injury

Toxina botulínica: uma nova opção para o tratamento da neuralgia pós-herpética?

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