Botulinum toxin type A treatment for persistent neuropathic pain in the soles after cervical spinal cord injury: A case report

Turk J Phys Med Rehab, 2024 · DOI: 10.5606/tftrd.2024.13941 · Published: December 19, 2023

Spinal Cord Injury Pharmacology Pain Management

Simple Explanation

This case report discusses a 42-year-old female with neuropathic pain in her soles due to cervical spinal cord injury. The patient had been experiencing this pain for eight years and had not found relief from various oral medications. The patient was treated with subcutaneous injections of botulinum toxin type A (BTX-A) in her soles. Over a six-month follow-up period, the patient's pain levels, mood, and overall quality of life improved. This suggests that BTX-A injections may be a viable option for treating neuropathic pain in the soles of individuals with spinal cord injuries when other treatments have failed.

Study Duration

6 Months

Participants

One 42-year-old female

Evidence Level

Level IV, Case Report

Key Findings

1
Daytime and nighttime pain levels (Visual Analog Scale) improved after botulinum toxin type A injection.
2
Neuropathic Pain Questionnaire scores improved during the six-month follow-up.
3
Short Form-36 scores, indicating quality of life, improved during follow-up.

Research Summary

This case report describes a 42-year-old female with persistent neuropathic pain in her soles following a cervical spinal cord injury. The patient had been experiencing this pain for eight years and had not found relief from various oral medications. The patient was treated with subcutaneous injections of botulinum toxin type A (BTX-A) in her soles. The patient was evaluated in the first, second, third, fourth, and sixth months after the injection. The study found that quality of life, depression, and neuropathic pain scores improved during six months of follow-up after local injection of BTX-A in a patient with neuropathic pain below the level of the SCI.

Practical Implications

Potential Treatment Option

Subcutaneous BTX-A injections may be a useful treatment option for neuropathic pain in the soles after cervical spinal cord injury, especially when oral medications are ineffective.

Improved Quality of Life

BTX-A injections can improve the quality of life, reduce depression, and alleviate neuropathic pain in patients with SCI.

Minimally Invasive

Botulinum toxin type A has no systemic side effects at current doses, and it is nonaddictive and minimally invasive.

Study Limitations

1
The maximum dose of BTX-A used to treat neuropathic pain varies widely in the literature.
2
The intensity of pain can be influenced by various daily factors, such as the individual's mood and exposure to stress.
3
Exclusion of small fiber neuropathy could not be definitively confirmed through electrophysiological methods.

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