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Abstract
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Background and Aims Pain is a sensory and emotional experience associated with actual or potential tissue injury. Neuropathic pain results from injury or disease affecting the somatosensory system, often becoming chronic and severely impacting life quality.
Methods A 61-year-old hypertensive male (90kg, 1.70m) presented with chronic neuropathic pain (VAS 10) in the right hand, since three years ago after blunt trauma to the right median nerve. The pain was refractory to analgesics, NSAIDs, and opioids, with allodynia in the palm and first three fingers. Thermography showed hyporadiation in the median nerve dermatome. Initial therapy with Duloxetine (60mg/day) and Pregabalin (300mg/day) provided partial relief (VAS 8). He underwent three ketamine infusions (0.3mg/kg/h) and a stellate ganglion block (0.5% lidocaine, 6ml) with temporary improvement. Intradermal botulinum toxin type A (100U) was administered, resulting in 50% pain reduction after two weeks, lasting 14 weeks. A second application provided more significant pain, allodynia, and ectopic discharge improvement.
Conclusions Botulinum toxin (TxB-A) is increasingly used for pain management, beyond its muscle relaxation effects in dystonia. TxB-A reduces neurogenic inflammation and nociceptive neurotransmitter release, inhibiting Na+ channels in the nervous system. It has shown efficacy in treating migraines, post-herpetic and post-traumatic neuralgia, CRPS, and phantom pain with minimal side effects. Pain relief from TxB-A lasts 3 to 6 months, often requiring serial applications, with improved outcomes after the second or third application.
Botulinum Toxin Taken by HUPE( Pedro Ernesto University Hospital)