Botulinum toxin A for refractory neuropathic pain in supraorbital postherpetic neuralgia

This case series assesses the benefits of intracutaneous injection of botulinum toxin A (BTX-A) for the treatment of intractable pain of supraorbital postherpetic neuralgia (PHN) not responding to oral drug therapy. Three patients experiencing intractable pain of supraorbital PHN, which was not responding satisfactorily to oral pregabalin and oral amitriptyline therapy, were managed with the intracutaneous injection of BTX-A in the affected dermatomes. Postinjection during each visit at 2, 4, 6, 8, 10, and 16 weeks, the Numeric Rating Scale pain score of the patients was assessed (0: painless; 10: maximum pain). There was a significant reduction in the severity of pain after BTX-A injection, and subsequently, the oral medications were significantly reduced thereafter. Hence, BTX significantly decreases the severity of intractable pain in supraorbital PHN patients.