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Pract Neurol 2021 Jun 9. Epub 2021 Jun 9.

Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK

Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Read More

Drug Res (Stuttg) 2021 Jun 7. Epub 2021 Jun 7.

Universitair Ziekenhuis - Vrije Universiteit Brussel UZ-VUB.

Acute otitis media is a common middle ear infection in children with the predominant symptoms of hearing impairment and pain. If antibiotics are given, they need time to have an effect on the inflammation, so the focus is on pain control. For pain management local anesthetics have the advantage of lesser systemic side effects but are still subject to scrutiny. Read More

Eur J Gastroenterol Hepatol 2021 Jun 3. Epub 2021 Jun 3.

Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.

Functional anorectal is idiopathic and characterised by severe and potentially intractable anorectal pain. The current review aims to appraise available evidence for the management of functional anorectal pain and synthesise reported outcomes using network meta-analysis. PubMed, CENTRAL and Web of Science databases were searched for studies investigating treatments for functional anorectal pain. Read More

Toxicon 2021 Jun 1;199:60-67. Epub 2021 Jun 1.

Department of Children's Rehabilitation, Lithuanian University of Health Sciences, Lithuania. Electronic address:

This review aims to determine the analgesic efficacy of botulinum toxin (BTX) for the management of pain in children with cerebral palsy (CP). During July and August 2020, a systematic literature search was performed using a mixture of subject headings and free text. The eligibility criteria for inclusion in the review were: (1) interventional studies, (2) participants: children aged 0-18 with CP, (3) participants were treated with BTX, (4) an outcome measure of pain or satisfaction with pain management, and (5) published in an English-language peer-reviewed journal. Read More

Bone Joint J 2021 Jun;103-B(6):1127-1132

Foot and Ankle Unit, The Royal National Orthopaedic Hospital, London, UK.

Aims: To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle.

Methods: We carried out a retrospective search of our records from 2000 to 2019 of patients seen in our adult tertiary referral foot and ankle unit with a diagnosis of functional dystonia.

Results: A total of 29 patients were seen. Read More

Acta Derm Venereol 2021 May 27. Epub 2021 May 27.

Department of Dermatology and Paediatric Dermatology, National Reference Center for Rare Skin Diseases, Saint-André Hospital, FR-33000 Bordeaux, France.

The management of digital ulcers in systemic sclerosis (SSc) is difficult. While the 2017 European League Against Rheumatism (EULAR) guidelines clearly defined the use of systemic therapies for digital ulcers, little is known about the efficacy of locoregional treatments. The aim of this review is to systematically assess the spectrum of published locoregional therapies for digital ulcers. Read More

Neurol India 2021 Mar-Apr;69(Supplement):S219-S227

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Background: Occipital neuralgia (ON) is a primary headache disorder characterized by sharp, shooting, or electric shock-like pain in the distribution of the greater, lesser, or third occipital nerves.

Aim: To review the existing literature on the management of ON and to describe our technique of an endoscopic-assisted approach to decompress the GON proximally in areas of fibrous and muscular compression, as well as distally by thorough decompression of the occipital artery from the nerve.

Methods: Relevant literature on the medical and surgical management of ON was reviewed. Read More

Pain Manag 2021 May 13. Epub 2021 May 13.

Department of Orthodontics, Ingá University Center UNINGÁ, Maringá, Brazil.

This prospective controlled clinical study aimed to evaluate the effect of botulinum toxin Type A (BTX-A) on pain control and quality of life (QoL) in patients with chronic myofascial pain. Patients with chronic myofascial pain were randomly divided into two groups (n = 20): counseling and self-care and Michigan-type occlusal splint (MOS) (CG-control group) or BTX-A injection (BTX-AG). The pain was evaluated with visual analogue scale and QoL with the oral health impact profile-14 (OHIP-14) questionnaire. Read More

Am J Transl Res 2021 15;13(3):1075-1084. Epub 2021 Mar 15.

Department of Pain Management, Hebei General Hospital Shijiazhuang 050051, Hebei Province, China.

Purpose: Currently, there is no favorable treatment plan for inflammatory pain, so exploring new analgesics is still a research hotspot in this area. Cyclin-dependent protein kinase 5 (Cdk5) is a pain-related protein kinase, but its mechanism in inflammatory pain has not been clarified. This research aimed to explore the mechanism of Cdk5-synaptophysin (Syn)-soluble N-ethylmaleimide-sensitivity factor (NSF) attachment protein receptor (SNARE) in acute and chronic inflammatory pain. Read More

Pharmaceutics 2021 Mar 26;13(4). Epub 2021 Mar 26.

Department of Pain Research and Treatment, Jagiellonian University Medical College, 31-008 Krakow, Poland.

Neuropathic pain in humans results from an injury or disease of the somatosensory nervous system at the peripheral or central level. Despite the considerable progress in pain management methods made to date, peripheral neuropathic pain significantly impacts patients' quality of life, as pharmacological and non-pharmacological methods often fail or induce side effects. Topical treatments are gaining popularity in the management of peripheral neuropathic pain, due to excellent safety profiles and preferences. Read More

J Clin Med 2021 Mar 1;10(5). Epub 2021 Mar 1.

Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71106, USA.

Thoracic outlet syndrome comprises a group of disorders that result in compression of the brachial plexus and subclavian vessels exiting the thoracic outlet. Symptoms include pain, paresthesia, pallor, and weakness depending upon the compromised structures. While consensus in diagnostic criteria has not yet been established, a thorough patient history, physical exam, and appropriate imaging studies are helpful in diagnosis. Read More

Plast Reconstr Surg Glob Open 2021 Mar 26;9(3):e3453. Epub 2021 Mar 26.

Section of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada.

Abdominal anterior cutaneous nerve entrapment syndrome (ACNES) is an emerging diagnosis, with estimated incidence of 13%-30% of the adult population. It is a syndrome characterized by chronic abdominal pain caused by entrapment of cutaneous branches of thoracoabdominal nerves at the lateral border of the rectus abdominis muscle. If conservative treatment with pain medication, botulinum toxin, or lidocaine injections is inadequate, surgical management is indicated. Read More

Urol Ann 2020 Oct-Dec;12(4):301-308. Epub 2020 Oct 15.

Department of Urology, Guy's Hospital, London, UK.

To review all published evidence regarding the use of Electromotive Drug Administration (EMDA) for the management of urological conditions, focusing on efficacy and safety, and highlighting areas that require further study. The PubMed and Medline databases were searched up to July 23, 2019. All studies reporting the use of EMDA to enhance the intravesical administration of therapeutic drugs for urological conditions were included. Read More

BMJ Neurol Open 2020 21;2(1):e000015. Epub 2020 Jun 21.

Mobility and Specialised Rehabilitation Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Background/objective: Spasticity is a complex and common condition but there is a lack of 'real-world' data on goal setting and spasticity treatment, as well as identifying those features that might be associated with goal achievement. Our aim was to provide such data.

Methods: Prospective attenders at a multi-disciplinary spasticity clinic over 2 years followed for consecutive appointments. Read More

J Pain Res 2021 25;14:549-560. Epub 2021 Feb 25.

Biostatistics Department, Pharmerit Inc., Bethesda, MD, USA.

Background: Nonsteroidal anti-inflammatory drugs are widely used for migraine, but gastrointestinal tolerability limits use. We previously reported results from the first treatment period of this 2-period, randomized, controlled study comparing DFN-15-an oral, ready-made liquid solution of a selective cyclo-oxygenase-2 inhibitor celecoxib-with placebo for the acute treatment of a moderate-severe migraine attack. Herein, we report the effects of treatment for the second treatment period. Read More

J Rehabil Med 2021 02 24;53(2):jrm00157. Epub 2021 Feb 24.

Departmant of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom. E-mail:

Objective: To assess the longitudinal effects of integrated spasticity management incorporating repeated cycles of botulinum toxin A type A (BoNT-A) over 2 years.

Methods: The Upper Limb International Spasticity study was a prospective, observational, cohort study following adult patients over 2 years of integrated upper-limb spasticity management including repeat botulinum toxin (BoNT-A) treatment (any commercially-available product).

Results: A total of 1,004 participants from 14 countries were enrolled, of which 953 underwent ≥ 1 BoNT-A injection cycle (median 4 cycles) and had ≥ 1 goal attainment scaling assessment. Read More

J Pediatr Pharmacol Ther 2021 15;26(2):151-156. Epub 2021 Feb 15.

Objectives: Prevalence of chronic migraine in children can reach 7.7%, causing decreased school performance, difficulty with extracurricular activities (including sports, theater, or music), and changes in sleep and mood. Many studies confirm that botulinum toxin type A injections effectively alleviate chronic migraines in adults; however, the literature regarding children is sparse. Read More

Mov Disord 2021 Feb 17. Epub 2021 Feb 17.

Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil.

Background: Hereditary spastic paraplegia presents spasticity as the main clinical manifestation, reducing gait quality and producing incapacity. Management with botulinum toxin type A (BoNT-A) is not well elucidated. The objective of the current study was to evaluate the efficacy and safety of BoNT-A in patients with hereditary spastic paraplegias. Read More

Cureus 2021 Jan 5;13(1):e12511. Epub 2021 Jan 5.

Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA.

Raynaud's phenomenon (RP) is a vasospastic disorder of the digital blood vessels leading to pain, paresthesias, and pallor in response to cold or stress. RP can develop secondary to a number of pathologies or factors, including the use of chemotherapy agents. Typical first-line therapies for secondary RP may be contraindicated in patients with certain comorbidities. Read More

Eur Urol Focus 2021 Jan 29. Epub 2021 Jan 29.

Kantonsspital St. Gallen, St. Gallen, Switzerland.

Context: Patients with chronic pelvic pain syndrome (CPPS) may have pain refractory to conventional management strategies. Botulinum toxin A (BTX-A) is a potential therapeutic option.

Objective: To evaluate the benefits and harms of BTX-A injections in the treatment of CPPS. Read More

Rehabilitacion (Madr) 2021 Jan 16. Epub 2021 Jan 16.

Unidad Gestión Clínica Medicina Física y Rehabilitación, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España; Grupo iRehab, Instituto de Investigación e Innovación Biomédica de Cádiz, Cádiz, España.

Objective: This study aimed to describe our experience with a protocol based on sevoflurane sedation to control pain and agitation during botulinum toxin-A (BoNT-A) infiltration in children with cerebral palsy (CP), especially in terms of safety and efficacy.

Material And Methods: We conducted a retrospective observational study of patients diagnosed with CP who underwent BoNT-A infiltration with sevoflurane sedation from November 2012 to December 2019. Demographic, clinical and functional characteristics, the effectiveness of sedation, adverse events (AE) and professional satisfaction were reviewed. Read More

Headache 2021 Feb 12;61(2):392-395. Epub 2021 Jan 12.

Department of Neurology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.

Objectives/background: Auriculotemporal neuralgia is a rare headache disorder. Anesthetic nerve blockade seems to be effective in most cases; however, literature is scarce about the management of refractory cases.

Methods: Case report. Read More

Toxins (Basel) 2020 Dec 22;13(1). Epub 2020 Dec 22.

Toxines Bacteriennes, Institut Pasteur, 75724 Paris, France.

Botulinum neurotoxins (BoNTs) show increasing therapeutic applications ranging from treatment of locally paralyzed muscles to cosmetic benefits. At first, in the 1970s, BoNT was used for the treatment of strabismus, however, nowadays, BoNT has multiple medical applications including the treatment of muscle hyperactivity such as strabismus, dystonia, movement disorders, hemifacial spasm, essential tremor, tics, cervical dystonia, cerebral palsy, as well as secretory disorders (hyperhidrosis, sialorrhea) and pain syndromes such as chronic migraine. This review summarizes current knowledge related to engineering of botulinum toxins, with particular emphasis on their potential therapeutic applications for pain management and for retargeting to non-neuronal tissues. Read More

BMJ Case Rep 2020 Dec 22;13(12). Epub 2020 Dec 22.

College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA

Three patients ranging from 49 to 61 years-old presented to our pain clinic after failing multiple treatment attempts for debilitating, chronic post-traumatic headaches, neck pain and involuntary muscle spasm following gunshot wounds to the head, neck and face. Concurrent cervical dystonia was noted in each patient on presentation. All patients were treated with onabotulinumtoxin A (ONA) injections in the head and neck. Read More

Toxins (Basel) 2020 12 17;12(12). Epub 2020 Dec 17.

Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB T2N 2T9, Canada.

Botulinum toxin type A has been used in the treatment of chronic migraine for over a decade and has become established as a well-tolerated option for the preventive therapy of chronic migraine. Ongoing research is gradually shedding light on its mechanism of action in migraine prevention. Given that its mechanism of action is quite different from that of the new monoclonal antibodies directed against calcitonin gene-related peptide (CGRP) or its receptor, it is unlikely to be displaced to any major extent by them. Read More

Dermatol Surg 2021 May;47(5):678-683

Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt.

Background: Palmar hyperhidrosis is a common disorder of excessive sweating due to over-stimulation of cholinergic receptors on eccrine glands.

Objective: To compare the efficacy of laser-assisted drug delivery of onabotulinum toxin A (BoNTA) and intradermal BoNTA injections in the management of palmar hyperhidrosis.

Patients And Methods: This intrapatient comparative study was conducted on 30 adult patients with idiopathic palmar hyperhidrosis. Read More

Clin Shoulder Elb 2019 Dec 1;22(4):227-234. Epub 2019 Dec 1.

Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.

Lateral epicondylitis, also known as 'tennis elbow', is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. Read More

Front Neurol 2020 27;11:591418. Epub 2020 Nov 27.

Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.

Cervical dystonia (CD) is a rare disorder, and health care providers might be unfamiliar with its presentation, thus leading to delay in the initial diagnosis. The lack of awareness displays the need to highlight the clinical features and treatment in cervical dystonia. In our cohort, we have identified an earlier age of onset in men, despite an overall preponderance of affected women. Read More

J Int Med Res 2020 Dec;48(12):300060520977416

Department of Pain Management, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China.

Objective: We aimed to perform a network meta-analysis that combined both direct and indirect evidence to compare the relative efficacy of interventional therapies to treat patients with postherpetic neuralgia (PHN) and to determine the treatments' superiority and validity.

Method: A conventional paired meta-analysis was performed. This was followed by a network meta-analysis using the Bayesian framework. Read More

Am J Gastroenterol 2021 02;116(2):263-273

Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.

Hypercontractile esophagus (HE) is a heterogeneous major motility disorder diagnosed when ≥20% hypercontractile peristaltic sequences (distal contractile integral >8,000 mm Hg*s*cm) are present within the context of normal lower esophageal sphincter (LES) relaxation (integrated relaxation pressure < upper limit of normal) on esophageal high-resolution manometry (HRM). HE can manifest with dysphagia and chest pain, with unclear mechanisms of symptom generation. The pathophysiology of HE may entail an excessive cholinergic drive with temporal asynchrony of circular and longitudinal muscle contractions; provocative testing during HRM has also demonstrated abnormal inhibition. Read More