Disclosures: Alyssa L. Marulli, MD: Nothing to disclose

Case Description: The patient had a history of B cell lymphoma in remission after 4 cycles of HyperCVAD chemotherapy and subsequent development of CIPN. He was initially trialed on pregabalin by his oncologist unsuccessfully before referral to Rehabilitation Medicine. At the time of initial evaluation by rehab 1.5 years after chemotherapy completion, he demonstrated absent Achilles reflexes, decreased proprioception and allodynia of the feet limiting ambulation. He was trialed on multiple neuropathic pain relieving agents including topical analgesics, duloxetine, gabapentin, opioids, pregabalin and venlafaxine with limited relief or adverse side effects. A trial of 200 units of botulinum toxin type A was administered subcutaneously in a 1×1cm grid pattern evenly over the distal plantar and dorsal surfaces of both feet. The patient initially reported increased pain and swelling over the next 48 hours which subsequently improved. Two months after administration he was able to ambulate 3-4 blocks versus 25 feet prior and had a change in pain quality from stabbing/burning to a dull ache.

Setting: Quaternary care academic hospital clinic.

Patient: 41-year-old male with chemotherapy induced peripheral neuropathy (CIPN).

Assessment/Results: Over the course of the following 18 months, the patient’s dose and timing of botulinum toxin administration were adjusted according to his symptoms to a final dose of 400 units given every 5 months. He was able to return to being an unrestricted community ambulator.

Discussion: There is emerging evidence for use of botulinum toxin for neuropathic pain. The exact mechanism remains unclear but studies on mouse models suggest botulinum toxin may inhibit release of pain neuropeptides including substance P, calcitonin gene-related peptide and glutamate leading to decreased pain perception. Several case series have shown its efficacy in diabetic neuropathy, postherpetic and trigeminal neuralgia.

Conclusion: This is the first reported case, to our knowledge, of the use of botulinum toxin injections for the management of CIPN.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/role-for-botulinum-toxin-injection-in-the-management-of-chemotherapy-induced-peripheral-neuropathy-a-case-report/