Effect of subcutaneous injection of botulinum toxin A on spinal cord injury-associated neuropathic pain

Abstract

Study design:Case report.Objective:To present a case of spinal cord injury (SCI)-associated neuropathic pain treated with botulinum toxin A injection.Setting:Outpatient SCI clinic.Case report:Description of a case in the context of relevant literature on the subject.Results:A 51-year-old man with C3 AIS B tetraplegia (American Spinal Injury Association Impairment Scale B) visited our outpatient clinic due to severe ongoing neuropathic pain and associated allodynia and dysesthesia of the lower limbs. He had previously tried combinations of pregabalin, gabapentin and oxycontin but all failed to alleviate his neuropathic pain during the 2 years post trauma. With the patient's consent, he was treated with subcutaneous injections of clostridium type A botulinum toxin. Ten units of type A botulinum toxin subcutaneously injected into 10 most painful sites of each sole. The patient was reassessed at 4 and 8 weeks after his injection with botulinum toxin with significant improvement of his neuropathic pain.Conclusion:Subcutaneous injection of type A botulinum toxin was effective without side effects, on one case of refractory neuropathic pain due to SCI. This is the first article to report the use of type A botulinum toxin in neuropathic pain related to traumatic SCI. © 2014 International Spinal Cord Society All rights reserved.