Treatment of pain with botulinum toxin
Keywords:
botulinum toxin, pain, nociceptive, neuropathicAbstract
Botulinum toxin is widely used in the neurological practice for treatment of dystonia, as well as for treatment the nociceptive and neuropathic pain and headache. The mechanisms of antinociceptive effect are connected with direct decrease of the peripheral and indirect decrease of the central sensitization.
The neurotoxin blocks calcium-dependent release of neuropeptides and neurotransmitters, connected with pain, like noradrenaline, substance P, glutamate and CGRP, from the peripheral terminals of the afferent nociceptive nerve fibers. Botulinum toxin is used for treatment of different kinds of pain and myofascial pain syndromes that have poor response to other treatments. Recently the toxin is used for treatment of post Covid syndrome with myofascial pain and headache.
There are published data for treatment of pain in osteoarthritis, myofascial regional pain syndromes, temporomandibular dysfunction, bruxism, chronic nonspecific back pain, dysfunction of m. quadratus lumborum, myofascial m. iliopsoas syndrome, myofascial dysfunction of the thoracolumbar paravertebral muscles, myofascial m. piriformis syndrome, the thoracic outlet syndrome, the plantar fasciitis and tennis elbow syndrome.
There are data for improvement of neuropathic pain in patients with diabetic painful neuropathy, the trigeminal, postherpetic and occipital neuralgias, vulvodynia, chronic pelvic pain and proctalgia fugax. The botulinum toxin is approved for prophylactic treatment of chronic migraine, and is used for prophylactic treatment of episodic migraine with frequent headache attacks. It is as effective as topiramate. Three different treatment methods are used – with toxin injection in fixed points, with injection in points depending on pain localization and a combined method – with injection in fixed frontal points and additional injection in points depending of pain localization.
Published data on botulinum toxin treatment of chronic tension type headache are controversial. However, in the clinical practice the same method as the one used for prophylactic treatment of chronic migraine is used for treatment of chronic tension type headache. The botulinum toxin treatment of chronic daily headache and posttraumatic headache (acute, chronic and after whiplash) is also effective.
In conclusion recently botulinum toxin is widely used in the clinical practice for treatment of different pain types, due to its good clinical efficacy, lack of side effects and drug interactions. etamol) are also used.
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