Use of Botulinum Toxin for Pain Management: A Systematic Review

Abstract

The Botulinum Toxin Type A (BTX-A) is an effective and safe therapeutic agent for chronic pain management, according to this systematic review synthesizing evidence from 2018 to 2025. The review included 37 studies (N=3,247) of moderate-to-high methodological quality. BTX-A provides a clinically significant pain reduction (≥50%) with an effect duration of 12 to 24 weeks. Its mechanism of action is biphasic: besides inhibiting acetylcholine, it blocks the release of nociceptive neurotransmitters (Substance P, CGRP, glutamate). Indications with Level A evidence include chronic migraine (VAS reduction from 8.4→4.2) and cervical dystonia. Encouraging results were reported in refractory oncological pain (VAS reduction 8.2→4.1, with 35% reduction in opioid use) and focal neuropathic pain. The safety profile is highly favorable, with a low overall incidence of adverse events (≈0.8%). The most common events are localized muscle weakness (2.3%) and post-injection headache, all self-limiting. Ultrasound-guided injection techniques have further enhanced procedure precision and safety. BTX-A is established as a valuable tool within the multidisciplinary pain framework.