What are the mechanisms of action for botulinum toxins in pain management?

Updated: Mar 11, 2019
  • Author: Heather Rachel Davids, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Botulinum toxin's putative success in pain management was originally attributed to its ability to block acetylcholine from being released at the synapse. One important feature of botulinum toxin in pain treatment is that the neurotoxin is thought to act only on motor nerve endings while sparing sensory nerve fibers from its effects. Subsequently, however, effects of botulinum toxin on nociceptive neurons were demonstrated in preclinical studies. [4, 5, 6, 7] Thus, analgesic effects are likely to occur, but not as a consequence of blocking afferent sensory fibers at the site of injection; rather, they have been attributed to secondary effects that may be the result of muscle paralysis, improved blood flow, the release of nerve fibers under compression by abnormally contracting muscle, and, perhaps more importantly, the effects of the toxin on nociceptive neurons.

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