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Ascensio-Mercado M, Olea MS, Rodrigues AT, Espinoza Morales K, Llavador Ros JJ, Yamak Altinpulluk E, H S-ZC, Galluccio F F-PM: Intraneural Injection of Botulinum Toxin-A in Palliative Care and Unresponsive Neuropathic Pain. Asia Pacific J Pain 2023; 33: 25-30

September 19, 2023

Neuropathic pain has different causes including surgery, trauma, viral infections, cancer, vascular malformations, alcoholism, neurological conditions such as multiple sclerosis, and metabolic conditions such as diabetes. Although there are various medical treatments for chronic neuropathic pain, these treatments may have limited or weak evidence, as well as interventional treatments, which have short-term efficacy and therefore require repeated interventions over time. Botulinum toxin type-A (BT-A) has been used for its analgesic effects in different pain situations. There are several potential mechanisms of action of BT-A, which are currently being researched. We report a series of three cases where ultrasound-guided intraneural infiltration with BT-A was administered as compassionate use for successful treatment of persistent neuropathic pain. This method may be effective for patients with persistent neuropathic pain and provide long-lasting effects. More studies, including randomized and controlled trials, are required to confirm the effectiveness of the treatment. Until more evidence arrives, intraneural injection of BT-A can be considered when conventional treatment has failed.
Keywords: botulinum toxin-A, neuropathic pain, palliative care.