Botox for neuropathic pain

[drg123]

Has anyone here successfully used Botox (subcutaneous) for neuropathic pain (e.g. diabetic neuropathy).
The Europeans have been using for some time and there are numerous good studies

https://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2816%2900017-X/fulltext

I don't think Botox is approved here for this indication but one could do off-label, cash pay?
Thoughts?

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[DODOCSS]

Yes. Post thoracotomy pain.

 

[drg123]

Yes. Post thoracotomy pain.

How did you handle the finances? Cash pay or did you get it covered by insurance somehow? Or did you call it a 'trigger point injection'?

 

[clubdeac]

Yes for PHN…was at the VA

 

[MitchLevi]

Botox in a scar or a neuroma is helpful. Neuroma injxns with Botox are painful.

 

[GlowInTheDark]

Yes. Post thoracotomy pain.

Done as an ICNB?

 

[DODOCSS]

Done as an ICNB?

surrounding the scar

 

[clubdeac]

Done as an ICNB?

No it actually involved VI-II. Just injected the the face in those two distributions in the face. There are several papers out there describing the technique

 

[Orin]

I've done it in CRPS as they'll sometimes have a focal dystonia, and then use the rest in a grid pattern after a nerve block proximal. If you're doing it for pure neuropathic pain, it would be cash pay or done for VA/etc.

Key thing here is to just do SQ injections as you're not trying to get into the muscle at all.

 

[SeniorWrangler]

Has anybody used Xeomin for this? Cheaper and it’s off label either way.

 

[joshmir]

Not sure if this is helpful, but years ago, I spoke with the medical science liaison for xeomin

He was a pharmacist at the VA

He said that they had done an internal data review at the VA and found that for what they had used xeomin for, the efficacy was non-inferior to Botox, at a conversion rate of 1:1 unit

If that guy is still the medical science liaison, he may be able to query their database for that

But then, again, he would still be the medical science liason and perhaps be biased in favor of xeomin