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Intradermal Botulinum Toxin Type A, In
Treating Pain Syndromes
J. Krusz
Posted: September 2005  
Journal of Pain, Vol. 6, March 2005

It is well known that botulinum toxin, type A (BoNTA) relieves the pain associated with cervical dystonia or other chronic neuromuscular conditions. Recently, intradermal botulinum toxin type B was shown to relieve migraines of cervical origin, suggesting an effect on afferent sensory nervous input to the spinal cord. In this ongoing study, this new administration technique was used in a sampling of TMJ pain, scar pain, CRPS pain, diabetic neuropathy, carpal tunnel pain and trigeminal neuralgia.

The initial data in pain patients who had failed other attempts at treatment of their symptoms, suggests that BoNTA is effective when given intradermally. Tolerability is also excellent. Once again, it has implications for the exact mechanisms of BoNTA’s effect on pain mechanisms, likely at the level of the spinal cord. Recently, BoNTA has been shown, largely in vitro or in animal models, to reduce Substance P, glutamate and CGRP. Double-blind studies are needed to replicate these initial observations in common painful disorders.