Ann Rehabil Med.  2017 Dec;41(6):1088-1092. 10.5535/arm.2017.41.6.1088.

Botulinum Toxin Type A Injection for Neuropathic Pain in a Patient With a Brain Tumor: A Case Report

• Nam KE
• Kim JS
• Hong BY
• Sul B
• Choi H
• Jun SY
• Lim SH

• KMID: 2400295
• DOI: http://doi.org/10.5535/arm.2017.41.6.1088

Abstract

Neuropathic pain is usually managed pharmacologically, rather than with botulinum toxin type A (BTX-A). However, medications commonly fail to relieve pain effectively or have intolerable side effects. We present the case of a 62-year-old man diagnosed with an intracranial chondrosarcoma, which was removed surgically and treated with radiation therapy. He suffered from neuropathic pain despite combined pharmacological therapy with gabapentin, amitriptyline, tramadol, diazepam, and duloxetine because of adverse effects. BTX-A (100 units) was injected subcutaneously in the most painful area in the posterior left thigh. Immediately after the injection, his pain decreased significantly from 6/10 to 2/10 on a visual analogue scale. Pain relief lasted for 12 weeks. This case report describes intractable neuropathic pain caused by a brain tumor that was treated with subcutaneous BTX-A, which is a useful addition for the management of neuropathic pain related to a brain tumor.

Keyword

Botulinum toxins; Neuralgia; Brain neoplasms

MeSH Terms

Amitriptyline
Botulinum Toxins*
Botulinum Toxins, Type A*
Brain Neoplasms*
Brain*
Chondrosarcoma
Diazepam
Duloxetine Hydrochloride
Humans
Middle Aged
Neuralgia*
Thigh
Tramadol
Amitriptyline
Botulinum Toxins
Botulinum Toxins, Type A
Diazepam
Duloxetine Hydrochloride
Tramadol

Figure

• 

  Fig. 1 (A, B) T2-weighted magnetic resonance imaging of the brain shows atrophy of the right brainstem without tumor relapse.

• 

  Fig. 2 T2-weighted magnetic resonance imaging of the brain (A, axial view; B, coronal view) shows a 1.9 cm× 1.4 cm multilobular lesion (arrow) with an intense signal and heterogeneous enhancement of the right clivus, jugular foramen, and hypoglossal canal. Computed tomography of the paranasal sinuses (C, axial view; D, coronal view) shows a mass (arrow) with soft tissue attenuation involving the right petroclival region.

• 

  Fig. 3 Schematic representation of botulinum toxin type A injection in the posterior aspect of the left thigh using a grid pattern (16 points).

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