Botulinum Toxin Treatment of Neuropathic Pain

Shivam Om Mittal, Delaram Safarpour, Bahman Jabbari

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Neuropathic pain (NP), a common form of human pain, often poorly responds to analgesic medications. In this review the authors discuss the pathophysiology and conventional treatment of neuropathic pain and provide evidenced-based statements on the efficacy of botulinum neurotoxins (BoNTs) in this form of pain. The level of efficacy for BoNT treatment in each category of NP is defined according to the published guidelines of the American Academy of Neurology. The data indicate that BoNT treatment (most of the literature is with onabotulinumtoxinA) is effective (level A evidence) in postherpetic neuralgia and trigeminal neuralgia. It is probably effective (level B) in posttraumatic neuralgia and painful diabetic neuropathy. The data on complex regional pain syndrome, carpal tunnel syndrome, occipital neuralgia, and phantom limb pain are preliminary and await conduction of randomized, blinded clinical trials. Much remains to be learned about the most-effective dosage and technique of injection, optimum dilutions, and differences among BoNTs in the treatment of neuropathic pain.

Original languageEnglish (US)
Pages (from-to)73-83
Number of pages11
JournalSeminars in Neurology
Issue number1
StatePublished - Feb 1 2016
Externally publishedYes


  • botulinum toxin
  • carpal tunnel syndrome
  • complex regional pain syndrome
  • diabetic neuropathy
  • neuropathic pain
  • occipital neuralgia
  • phantom pain
  • postherpetic neuralgia
  • posttraumatic neuralgia
  • trigeminal neuralgia

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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