The Use of Botulinum Toxin in Pain Management: Basic Science and Clinical Applications

Abstract

Summary: Pain is an unpleasant experience resulting from either tissue damage or insults to the somatosensory system. Approaches to pain management evolve as we better understand both pain pathways and the tools available to interrupt these. The interest surrounding botulinum neurotoxin as a chemodenervating agent has expanded to include its potential applications in painful pathologies, both within and beyond the confines of plastic surgery. In this article, the authors discuss botulinum neurotoxin’s mechanism of action as it pertains to both muscular paralysis and its interplay in the modulation of proinflammatory pain mediators. In addition, the authors review evidence supporting the use of botulinum neurotoxin in common painful conditions, in order to prepare the readership to aptly provide their patients with evidence-based recommendations. After reading this article, the participant should be able to discuss both mechanism of action and common applications of botulinum neurotoxin in painful conditions.

“Migraine Surgery and Determination of Success Over Time by Trigger Site: A Systematic Review of the Literature”

“…Despite the efforts to determine the trigger site before surgery, 20,[40][41][42][43][44][45] the rates of migraine surgery success vary between studies. 8 Possible reasons for incomplete headache migraine elimination are the unmasking of untreated trigger sites, the incorrect selection of the trigger site, the clinical presentation of multiple trigger sites at the same time and, as a consequence, the lack of specificity of outcomes for each trigger site and the time when these outcomes were evaluated.…”

New anatomical insights of the superficial branch of the zygomaticotemporal nerve for treating temporal migraines: An anatomical study

“…Although the sZTN does not pass through the temporalis muscle, migraine headaches arise because of inflammation caused by irritation of the surrounding structures. BoNT‐A is known to inhibit the release of pain‐related neurotransmitters and neuropeptides and reduce peripheral sensitization (Gazerani et al, 2010; Hehr et al, 2020; Janis et al, 2017; Nahabet et al, 2015; Robertson & Garza, 2012). Therefore, to successfully treat temporal migraines, it is necessary to inject not only the main branch of the zygomaticotemporal nerve but also the sZTN (Figure 6B).…”

“…We believe that this approach will minimize the burden on surgeons to perform additional surgical procedures because it shares the same endoscopic entry points and pathways of conventional migraine surgery (Figure 6A). to inhibit the release of pain-related neurotransmitters and neuropeptides and reduce peripheral sensitization (Gazerani et al, 2010;Hehr et al, 2020;Janis et al, 2017;Nahabet et al, 2015;Robertson & Garza, 2012). Therefore, to successfully treat temporal migraines, it is necessary to inject not only the main branch of the zygomaticotemporal nerve but also the sZTN (Figure 6B).…”

Botulinum toxin for chronic pain: What's on the horizon?

“…The following discussion explores the evidence for potential emerging indications for BoNT. The TABLE 1,5, summarizes what we know to date.…”

“…Pain reduction in BoNT group was significantly greater than placebo Trigeminal neuralgia 1,5,27 Postherpetic neuralgia Phantom limb pain and residual limb pain 1,5 Case series and placebocontrolled RCT Both BoNT and placebo showed reduction of pain; no statistical difference noted Complex regional pain syndrome 5,[38][39][40] Case series and RCT Reduction of pain with BoNT injections…”