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
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).