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Subcutaneous and Perineural Botulinum Toxin Type A For Neuropathic Pain: A Descriptive Review

Fabregat, Gustavo MD*; De Andrés, José MD, PhD, FIPP; Villanueva-Pérez, Vicente L. MD*; Asensio-Samper, Juan M. MD*

doi: 10.1097/AJP.0b013e31827eafff
Review Articles

Objective: Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of multiple conditions with a component of localized muscle spasm. Recent studies suggest that botulinum toxin is effective in the treatment of neuropathic pain syndromes such as postherpetic neuralgia or painful scars.

Methods: We searched the PubMed and OvidSP databases. We also included cross-referencing bibliographies from primary and review articles.

Discussion: In this descriptive review, we evaluate the usefulness, safety, and potential pathophysiological mechanism of botulinum toxin type A for treatment of painful disorders with neuropathic component such as postherpetic neuralgia, diabetic neuropathy, or trigeminal neuralgia.

Conclusions: 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.

*Multidisciplinary Pain Management Department

Critical Care and Multidisciplinary Pain Management Department, School of Medicine of Valencia, General University Hospital, Valencia, Spain

The authors declare no conflict of interest.

Reprints: Gustavo Fabregat, MD, Multidisciplinary Pain Management Department, Hospital General Universitario, Avda. Tres Cruces s/n, Valencia 46014, Spain (e-mail:

Received February 13, 2012

Accepted November 18, 2012

© 2013 by Lippincott Williams & Wilkins