Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum and related species. There are seven types of botulinum toxin, types A–G, but only types A and B are FDA approved to be used in humans. There are multiple uses for Botox in the management of pain, but the only FDA-approved indications are cervical dystonia, chronic migraine, and limb spasticity. Further research is needed to establish efficacy in other pain conditions such as neuralgias and myofascial pain syndromes. Dosing is variable based on the type used and the area being injected. The duration of action of botulinum toxin is dependent on the type of botulinum used A vs. B, dose, method of administration, and the type of synapse affected (muscle vs. cholinergic synapse).
KeywordsBotox Botulinum toxin Onabotulinum toxin A Rimabotulinum toxin B Headache Migraine Dystonia Neuropathy Neuralgia Myofascial pain