Beyond Conventional Analgesics: Updated Evidence Supporting Botulinum Toxin Type A for-Neuralgia Management

Area of Science:

• Neurology
• Pain Management
• Pharmacology

Background:

• Neuralgia is a chronic neuropathic pain condition often resistant to standard treatments.
• Botulinum toxin type A (BTX-A) shows promise for pain relief due to its analgesic properties.

Purpose of the Study:

• To synthesize evidence on BTX-A monotherapy's efficacy and safety for neuralgia.
• To address limitations in previous meta-analyses regarding dosage and concomitant medications.

Main Methods:

• Systematic search of major databases for randomized controlled trials (RCTs) up to September 2025.
• Adherence to PRISMA 2020 guidelines for study selection and data extraction.
• Random-effects models and subgroup analyses based on dosage and follow-up duration.

Main Results:

• Seven RCTs with 368 participants were analyzed.
• BTX-A significantly reduced pain intensity, attack frequency, and analgesic use.
• Improvements were noted in sleep quality, quality of life, and patient global impression.
• Low-dose BTX-A (<50 U) showed efficacy comparable to higher doses, sustained for ~3 months.
• No serious adverse events were reported.

Conclusions:

• BTX-A monotherapy offers significant pain relief and functional improvement for neuralgia patients.
• It serves as an effective option for refractory neuropathic pain, including trigeminal and postherpetic neuralgia.
• Further large-scale RCTs are needed to optimize treatment protocols.