Botulinum Toxin Reduction Pain in Postherpetic Neuralgia

Document Type : Original Article(s)

Authors

1 Associate Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Assistant Professor, Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Resident, Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Background: The most common complication of herpes zoster is postherpetic neuralgia (PHN), which can cause chronic and debilitating pain. In some patients, pain persists for weeks or even years after regression of the rash and many drugs and methods should be used to treat the pain. As many patients are elder and suffer from chronic diseases, they would be affected by drug complications. Recently, subcutaneous injection of botulinum toxin is used as a new method for controlling pain with little complications. There are a few case studies about effect of botulinum toxin injection to relieve pain. We assessed the effect of subcutaneous injection of botulinum toxin on relieving pain in postherpetic neuralgia.  Methods: In this intervention study, 15 patients suffer postherpetic neuralgia were enrolled by convincing sampling method. Information as age, sex, dermatome, place and duration of pain, and severity of pain were registered in patients. Then botulinum toxin injected 15 units per 10 cm² subcutaneously. Patients were followed in 2nd day, 2nd week, and 4th week after injection and pain was measured by visual analog score (VAS). Data were analyzed by Repeated Measure ANOVA test using SPSS16 software.Finding: Six patients were male and 9 were female. The mean age was 60 ± 4.5 year and duration of pain was 6.5 month. Mean of VAS in 2nd day, 2nd week, and 4th week were 6.4, 7.2, and 7.6 respectively. Patients’ pain in 4th week were decreased compare with before injection but the difference was not statistically significant (P = 0.06).Conclusion: It seemed that subcutaneously injection of botulinum toxin can relieve pain in postherpetic neuralgia. Hence this decrease in duration of the time was observed to be lesser, repetition of injection could be more effective for controlling the pain. 

Keywords

References

  1. Glynn C, Crockford G, Gavaghan D, Cardno P, Price D, Miller J. Epidemiology of shingles. J R Soc Med 1990; 83(10): 617-9.
  2. Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA. Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. BMJ 2000; 321(7264): 794-6.
  3. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352(22): 2271-84.
  4. Watson CP, Evans RJ, Watt VR, Birkett N. Postherpetic neuralgia: 208 cases. Pain 1988; 35(3): 289-97.
  5. Kost RG, Straus SE. Postherpetic neuralgia--pathogenesis, treatment, and prevention. N Engl J Med 1996; 335(1): 32-42.
  6. Bowsher D. Pathophysiology of postherpetic neuralgia: towards a rational treatment. Neurology 1995; 45(12 Suppl 8): S56-S57.
  7. Argoff CE. The Use of Botulinum Toxins for Chronic Pain and Headaches. Curr Treat Options Neurol 2003; 5(6): 483-92.
  8. Argoff CE. A focused review on the use of botulinum toxins for neuropathic pain. Clin J Pain 2002; 18(6 Suppl): S177-81.
  9. Lindner MD, Bourin C, Chen P, McElroy JF, Leet JE, Hogan JB, et al. Adverse effects of gabapentin and lack of anti-allodynic efficacy of amitriptyline in the streptozotocin model of painful diabetic neuropathy. Exp Clin Psychopharmacol 2006; 14(1): 42-51.
  10. Shannon HE, Love PL. Effects of antiepileptic drugs on attention as assessed by a five-choice serial reaction time task in rats. Epilepsy Behav 2005; 7(4): 620-8.
  11. Murinson BB. Botulinum toxin type A treatment of painful focal neuropathies: new evidence for efference of afferents. Ann Neurol 2008; 64(3): 236-8.
  12. Aitken RC. Measurement of feelings using visual analogue scales. Proc R Soc Med 1969; 62(10): 989-93.
  13. Dworkin RH, Portenoy RK. Pain and its persis-tence in herpes zoster. Pain 1996; 67(2-3): 241-51.
  14. Ellison N, Loprinzi CL, Kugler J, Hatfield AK, Miser A, Sloan JA, et al. Phase III placebo-controlled trial of capsaicin cream in the man-agement of surgical neuropathic pain in cancer patients. J Clin Oncol 1997; 15(8): 2974-80.
  15. Straus SE, Oxman MN. Varicella and herpes zoster. In: Freedberg IM, Eisen AZ, editors. Dermatology in general medicine. New York: McGraw-Hill Education, 1999. p. 2445-6.
  16. Gulick R. Herpes virus infecticns. In: Dover JS, editor. Pocket Guide to Cutaneous Medicine and Surgery. Philadelphia: W.B. Saunders Co, 1996: 1081.
  17. Watson CP. Postherpetic neuralgia. Neurol Clin 1989; 7(2): 231-48
  18. Smuts JA, Barnard PW. Botulinum toxin type A in the treatment of headache syndromes: a clinical report on 79 patients. Cephalagia 2000; 20: 332.
  19. Binder WJ, Brin MF, Blitzer A, Schoenrock LD, Pogoda JM. Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an open-label study. Otolaryngol Head Neck Surg 2000; 123(6): 669-76.
  20. Brin MF, Swope DM, O'Brien C, Abbasi S, Pogoda JM. BOTOX for migraine: double-blind, placebo-controlled, region-specific evaluation. Cephalgia 2000; 20: 421-2.
  21. Mauskop A, Basdeo R. Botulinum toxin A is an effective prophylactic therapy for migraines. Cephalagia 2000; 20(4): 422.
  22. Silberstein S, Mathew N, Saper J, Jenkins S. Botulinum toxin type A as a migraine preventive treatment. For the BOTOX Migraine Clinical Research Group. Headache 2000; 40(6): 445-50.
  23. de Ru JA, Buwalda J. Botulinum toxin A injec-tion into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache. J Laryngol Otol 2009; 123(4): 412-7.
  24. Wheeler AH. Botulinum toxin A, adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache 1998; 38(6): 468-71.
  25. Carruthers A, Langtry JA, Carruthers J, Robin-son G. Improvement of tension-type headache when treating wrinkles with botulinum toxin A injections. Headache 1999; 39(9): 662-5.
  26. Smuts JA, Baker MK, Smuts M, Stassen JM, Rossouw E, Barnard PW. Prophylactic treatment of chronic tension-type headache using botulinum toxin type A. Eur J Neurol 1999; 6(Suppl 4): S99-S102.
  27. Relja M. Treatment of tension-type headache by local injection of botulinum toxin. Eur J Neurol 1997; 4(Suppl 2): S71-3.
  28. Lew MF. Review of the FDA-approved uses of botulinum toxins, including data suggesting efficacy in pain reduction. Clin J Pain 2002; 18(Suppl 6): S142-S146.
  29. Snow BJ, Tsui JK, Bhatt MH, Varelas M, Hashimoto SA, Calne DB. Treatment of spasticity with botulinum toxin: a double-blind study. Ann Neurol 1990; 28(4): 512-5.
  30. Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 1993; 52(3): 259-85.
  31. Bennett GJ. Hypotheses on the pathogenesis of herpes zoster-associated pain. Ann Neurol 1994; 35(Suppl): S38-S41.
  32. Woolf CJ, Shortland P, Coggeshall RE. Periph-eral nerve injury triggers central sprouting of myelinated afferents. Nature 1992; 355(6355): 75-8.
  33. Cervero F, Laird JM. Mechanisms of touch-evoked pain (allodynia): a new model. Pain 1996; 68(1): 13-23.
  34. Effectiveness of botulinum toxin A against the segmental burning pain of spinal cord origin. Poster Presented in the International Conference 2002: Basic and Therapeutic Aspects of Botulinum and Tetanus Toxins; 2002 Jun 8-12; Hannover, Germany; 2002.
  35. Simpson LL. Identification of the characteristics that underlie botulinum toxin potency: implications for designing novel drugs. Biochimie 2000; 82(9-10): 943-53.
  36. Blasi J, Chapman ER, Link E, Binz T, Yamasaki S, De Camilli P, et al. Botulinum neurotoxin A selectively cleaves the synaptic protein SNAP-25. Nature 1993; 365(6442): 160-3.
  37. Hay JC. SNARE complex structure and function. Exp Cell Res 2001; 271(1): 10-21.
  38. Cui M, Khanijou S, Rubino J, Aoki KR. Subcu-
  39. taneous administration of botulinum toxin A reduces formalin-induced pain. Pain 2004; 107(1-2): 125-33.
  40. Petrenko AB, Yamakura T, Baba H, Shimoji K. The role of N-methyl-D-aspartate (NMDA) re-ceptors in pain: a review. Anesth Analg 2003; 97(4): 1108-16.
  41. Arezzo JC. Possible mechanisms for the effects of botulinum toxin on pain. Clin J Pain 2002; 18(6 Suppl): S125-32.
  42. Freund B, Schwartz M. Subcutaneous BTX-A in the treatment of neuropathic pain: a pilot study. Proceedings of the 38th Interagency Botulism Research Coordinating Committee Meeting; 2001 Oct 17-19; Easton, MD; 2001.
  43. Liu HT, Tsai SK, Kao MC, Hu JS. Botulinum toxin A relieved neuropathic pain in a case of postherpetic neuralgia. Pain Med 2006; 7(1): 89-91.
  44. Sotiriou E, Apalla Z, Panagiotidou D, Ioannidis D. Severe postherpetic neuralgia successfully treated with botulinum toxin A: three case reports. Acta Derm Venereol 2009; 89(2): 214-5.
  45. Ruiz HC, Bermejo PE. Botulinum toxin type A in the treatment of neuropathic pain in a case of postherpetic neuralgia. Neurologia 2008; 23(4): 259-62.
Journal of Isfahan Medical School
Volume 28, Issue 114 - Serial Number 114
September and October 2011
Pages 819-827

Files

History

  • Receive Date: 05 January 2011
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics