Author: Ramon L. Cuevas-Trisan
The emerging role of botulinum toxins as chemical neuromodulators, specifically in the management of chronic intractable painful syndromes, will be presented. There is compelling evidence showing that toxins modulate chronic neurogenic inflammation, commonly expressed as peripheral sensitization leading to central sensitization with allodynia and hyperalgesia. Existing medical literature will be discussed. Several cases successfully managed with type A botulinum toxins will be discussed, including chronic intractable headaches of several etiologies (migraine, posttraumatic, postintracranial bleed, etc), occipital neuralgia, intractable facial pain, temporomandibular joint pain syndromes, postradiation fibrosis, and other focal painful syndromes (ie, distal limb ischemic pain seen in Raynaud's phenomenon, temporal arteritis, and (others).