The Use of Botulinum Toxin-A for Neck Pain

Abstract

Botulinum Toxin Type-A (BoNT-A) is widely used and has been approved in the field of facial esthetic as well as in some neurological conditions. Its neurotoxin protein produced by bacteria called Clostridium botulinum as this two chain protein blocks the acetylcholine release at the NMJ through its action of the SNARE proteins which by this will temporarily inhibit striatal muscle contraction. There are different commercially available preparations like; Ona-botulinumtoxinA (BOTOX®), AbobotulinumtoxinA (Dysport®), and RimabotulinumtoxinB (Myobloc®).Recently, there was an interest in utilizing it for muscular neck pain and headache. These conditions can be chronic and difficult to treat. Although there are more consensus on migraine and cervical dystonia, the literature showed conflicting results and conclusions.1,2 A randomized double-blinded study showed a trend toward improvement in the BOTOX® group.3Another prospective study showed a significant reduction of pain intensity in patients receiving BoNT-A for refractory neck pain.