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. 2020 Feb;19(2):1058-1064.
doi: 10.3892/etm.2019.8301. Epub 2019 Dec 9.

Botulinum toxin A treatment for post-herpetic neuralgia: A systematic review and meta-analysis

Xin-Long Li  1 , Xu Zeng  1 , Shan Zeng  1 , Hai-Ping He  1 , Zhen Zeng  2 , Li-Lei Peng  1 , Li-Gang Chen  1
Affiliations

Botulinum toxin A treatment for post-herpetic neuralgia: A systematic review and meta-analysis

Xin-Long Li et al. Exp Ther Med. 2020 Feb.

Abstract

The present meta-analysis study aimed to investigate the safety and efficacy of local administration of botulinum toxin (BTX-A) vs. lidocaine in the treatment of post-herpetic neuralgia. A systematic search of the Cochrane Library, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, Chongqing VIP Information Co. and Chinese Biomedical Literature Database was performed to identify randomized controlled trials (RCTs) comparing BTX-A and lidocaine in the treatment of post-herpetic neuralgia. The primary outcomes were Visual Analogue Scale (VAS) pain scores at 1, 2 and 3 months after treatment and the effective rate. Secondary outcomes were scores on the McGill pain questionnaire and adverse event rate. A total of 7 RCTs comprising 752 patients were included. The VAS pain score was significantly lower at 1 month [mean difference (MD)=-2.31; 95% CI: -3.06, -1.56; P<0.00001)], 2 months (MD=-2.18; 95% CI: -2.24, -2.11; P<0.00001) and 3 months (MD=-1.93; 95% CI: -3.05, -0.82; P=0.0007) after treatment, the effective rate was significantly higher (odds ratio=2.9; 95% CI: 1.71, 4.13; P<0.0001) and scores on the McGill pain questionnaire were significantly lower (MD=-10.93; 95% CI: -21.02, -0.83; Z=2.12; P=0.03) in patients who received BTX-A for post-herpetic neuralgia compared to those who received lidocaine. There was no difference in the adverse event rate between treatments. In conclusion, BTX-A has potential as a safe and effective treatment option for post-herpetic neuralgia. Further large and well-designed RCTs are required to confirm this conclusion.

Keywords: botulinum toxin-a; efficacy; meta-analysis; post-herpetic neuralgia; safety.

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Figures

Figure 1.
Figure 1.
Flow chart of article screening and selection process.
Figure 2.
Figure 2.
Cochrane risk-of-bias assessment.
Figure 3.
Figure 3.
BTX-A vs. lidocaine for post-herpetic neuralgia: VAS pain score at 1 month of follow-up. VAS, Visual Analogue Scale; BTX-A, botulinum toxin A; df, degrees of freedom; IV, inverse variance; SD, standard deviation.
Figure 4.
Figure 4.
BTX-A vs. lidocaine for post-herpetic neuralgia: VAS pain score at 2 months of follow-up. VAS, Visual Analogue Scale; BTX-A, botulinum toxin A; df, degrees of freedom; IV, inverse variance; SD, standard deviation.
Figure 5.
Figure 5.
BTX-A vs. lidocaine for post-herpetic neuralgia: VAS pain score at 3 months of follow-up. VAS, Visual Analogue Scale; BTX-A, botulinum toxin A; df, degrees of freedom; IV, inverse variance; SD, standard deviation.
Figure 6.
Figure 6.
BTX-A vs. lidocaine for post-herpetic neuralgia: Effective rate. BTX-A, botulinum toxin A; df, degrees of freedom; M-H, Mantel-Haenszel.
Figure 7.
Figure 7.
BTX-A vs. lidocaine for post-herpetic neuralgia: McGill pain questionnaire. BTX-A, botulinum toxin A; df, degrees of freedom; IV, inverse variance; SD, standard deviation.
Figure 8.
Figure 8.
BTX-A vs. lidocaine for post-herpetic neuralgia: Adverse event rate. BTX-A, botulinum toxin A; df, degrees of freedom; M-H, Mantel-Haenszel.
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