Real-World Evaluation of Botulinum Toxin A in Focal Peripheral Neuropathic Pain: Longitudinal Outcomes

Presenter: E. Sole Cruz

Neuropathic pain (NP) is often found to be unresponsive to traditional treatment methods. This prospective observational study evaluated the effectiveness and safety of botulinum toxin type A (BT-A) in adults with chronic focal peripheral neuropathic pain that was refractory to standard treatments. Patients from two French pain centers received individualized BT-A injections at approximately 3-month intervals over 1 year. The primary outcome was the patient-reported percentage improvement after the first injection, assessed at follow-up visits from Cycles 2 to 5. Secondary outcomes included the Patient Global Impression of Change (PGIC), average pain intensity over the previous 8 days, and response patterns among early and late responders. A total of 82 patients received at least two BT-A treatment cycles and were included in the analysis. Mean self-reported improvement increased progressively from 30.7% at Cycle 2 to 51.0% at Cycle 5 (p < 0.001). Significant improvements were also observed in Patient Global Impression of Change scores and average pain intensity. Among the 59 patients evaluated at Cycle 3, 66% were classified as early responders, defined as achieving at least a 30% improvement. Patients who responded later also experienced significant benefit after the third injection. Botulinum toxin type A was generally well tolerated. End-of-dose effects were reported by 63.6% of patients, while 25.8% experienced mild, transient adverse events.

Overall, this real-world study suggests that repeated botulinum toxin type A treatment provides progressive and sustained improvement in patients with focal peripheral neuropathic pain, supporting continued treatment beyond the first two treatment cycles.

EAN 2026, June 27-30, Geneva, Switzerland.