Both Subcutaneous and Perineural Botulinum Treatments Advocated

Review has concluded both subcutaneous and perineural treatments are effective in neuropathic pains.

 Clin J Pain. 2013 Nov;29(11):1006-12.
Subcutaneous and perineural botulinum toxin type a for neuropathic pain: a
descriptive review.
Fabregat G, De Andrés J, Villanueva-Pérez VL, Asensio-Samper JM.

  • “On the basis of the analysis of the reports published in the literature, it would seem that fractioned peripheral subcutaneous and perineural injections of botulinum toxin type A may be useful for the treatment of various chronic pain conditions with neuropathic component.”

Comment – I have a patient with occipital neuralgia – gets zingers – I use 200 units: – 100 into greater, lesser and 3rd occipital nerves.  Then 100 units into hyperesthetic areas subcunaeously/intradermal every cm. or so.  I still have to use 5% lidocaine subcutaneously into occipital nerves but subject feels the botox does more of the work. 

Went to a program at Painweek in Las Vegas – speaker uses botulinum for migraines and gives his injections intradermal which could potentially avoid muscle/the droopy eyelid issue – had that happen recently injecting a corrigator – maybe intradermal would be safer there (patient did recover though).

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