Ukrainian National Consensus on Botulinum Therapy for Neuropathic Pain

Background: Neuropathic pain is a condition of complex nature arising from damage to or dysfunction of the sensory nervous system. Conventional treatment options (like antidepressants, anticonvulsants, and opioids) frequently have limited efficacy and substantial side effects. Thereat, increasing attention is being paid to botulinum toxin therapy (BTT) as a promising option for the treatment of neuropathic pain. Purpose: To develop the Ukrainian national consensus statement on the use of botulinum neurotoxin (BoNT) to treat neuropathic pain through the review of available literature, compilation of experience of Ukrainian specialists, and formulation of relevant practical recommendations. Methods: Our working group reviewed the current literature (including randomized clinical trials, systematic reviews and meta-analyses) and personal clinical observations related to the use of BoNT to treat painful neuropathic syndromes. Results: BoNT demonstrated high efficacy in the treatment of neuropathic pain, particularly in postherpetic neuralgia, painful diabetic neuropathy, trigeminal neuralgia, post-amputation pain, trauma sequelae, spinal cord injury and other conditions. Its major pain relief mechanisms include modulation of neuronal activity, blocking the release of pain neuromediators, and neuroplastic effects. The optimal dosage amount was found to vary from 50 to 300 units, depending on the affected area, with mostly subcutaneous or intradermal BoNT injections used. Conclusion: BTT is a safe promising treatment option for neuropathic pain and can be used either alone or in combination with other pain relief modalities. Our working group developed practical recommendations on BoNT indications, doses and injection techniques in painful neuropathic syndromes which can be implemented into clinical practice to improve patients’ quality of life.