The emerging use of botulinum toxins for the treatment of neuropathic pain.

There has been increasing interest in exploring the potential therapeutic benefit of the botulinum toxins in the management of neuropathic pain. Examples of neuropathic pain include painful diabetic polyneuropathy, postherpetic neuralgia (PHN), complex regional pain syndrome, trigeminal neuralgia and neuropathic low back pain. Other chronic pain syndromes may exhibit neuropathic features including migraine and fibromylagia but are not considered by most to be typical neuropathic pain states [1–3]. Xiao et al. in this issue of Pain Medicine report the results of their randomized controlled study evaluating the effect of subcutaneous injections of botulinum toxin type A (BOTOX) compared with lidocaine and placebo injections for the treatment of PHN [4]. As has been outlined elsewhere in this issue by Xiao et al., BOTOX is known to have analgesic properties with an increasing awareness of proposed mechanisms that underlie these analgesic benefits.