Not so Toxic After All! Botulinum Toxins in Chronic Pain Management

Author: Ramon L. Cuevas-Trisan

Botulinum toxins have been used for many years to manage a wide variety of chronic pain syndromes. This article will outline some of the published literature and clinical practice observations of the known uses of botulinum toxins in the management of a various chronic pain syndromes. Preclinical studies will be briefly summarized to provide a theoretical construct on which to build the mounting clinical evidence showing the virtues of botulinum toxins as safe and effective analgesic biologicals.

There are 4 botulinum toxin products commercially available for use in humans in the United States: 3 are serotype A toxins (onabotulinumtoxinA = Botox®, abobotulinumtoxinA = Dysport®, and incobotulinumtoxinA = Xeomin®) and the other is serotype B toxin (rimabotulinumtoxinB = Myobloc®). These biologicals share some basic properties but, given their manufacturing methods, biological potency assays, and final chemical composition, units of biological activity (dosing) are not interchangeable, effectiveness is not uniform in all applications, and side effect profiles are distinct for each.

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