Botulinum Toxin for Diabetic Neuropathic Pain?

Available drug therapies are inadequate for many patients with painful diabetic neuropathy. Basic science research suggests that botulinum toxin has inhibitory effects on biochemical mediators of neuropathic pain, and several small clinical studies have suggested that botulinum toxin reduces neuropathic pain independently of its known neuromuscular effects.

In an industry-supported double-blind crossover trial conducted in Taiwan, researchers randomized 20 patients with painful diabetic neuropathy involving the feet to receive intradermal injections of either botulinum toxin type A (12 injections, spaced in a 3 × 4 grid on the dorsum of each foot) or saline placebo. Twelve weeks later, each patient crossed over to the other treatment. At bas…