{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:52:04Z","timestamp":1774659124622,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T00:00:00Z","timestamp":1655337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>We treated a 51-year-old woman with refractory Complex Regional Pain Syndrome type I (CRPS-I) involving her left hand and forearm with subcutaneous injections of BoNT\/A. The injections were performed every 3 months, with a total of six treatments. Each treatment was able to effectively improve pain and motor impairment; however, the duration of the effect was limited to only a few months. BoNT\/A could improve patients\u2019 quality of life with CRPS; however, extensive clinical studies are needed to determine its role in clinical practice.<\/jats:p>","DOI":"10.3390\/toxins14060411","type":"journal-article","created":{"date-parts":[[2022,6,19]],"date-time":"2022-06-19T21:19:26Z","timestamp":1655673566000},"page":"411","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Subcutaneous BoNT\/A Injection for Intractable Pain and Disability in Complex Regional Pain Syndrome: A Case Report"],"prefix":"10.3390","volume":"14","author":[{"given":"Yan","family":"Tereshko","sequence":"first","affiliation":[{"name":"Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Dalla Torre","sequence":"additional","affiliation":[{"name":"Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Lettieri","sequence":"additional","affiliation":[{"name":"Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Belgrado","sequence":"additional","affiliation":[{"name":"Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gian Luigi","family":"Gigli","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariarosaria","family":"Valente","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/B978-0-444-62627-1.00026-3","article-title":"The Complex Regional Pain Syndrome","volume":"131","author":"Oaklander","year":"2015","journal-title":"Handb. Clin. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.pain.2005.09.036","article-title":"Evidence of Focal Small-Fiber Axonal Degeneration in Complex Regional Pain Syndrome-I (Reflex Sympathetic Dystrophy)","volume":"120","author":"Oaklander","year":"2006","journal-title":"Pain"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.pain.2010.05.002","article-title":"Quantitative Sensory Testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory Abnormalities in 1236 Patients with Different Neuropathic Pain Syndromes","volume":"150","author":"Maier","year":"2010","journal-title":"Pain"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.toxicon.2018.01.017","article-title":"Botulinum Toxin Treatment of Pain Syndromes -an Evidence Based Review","volume":"147","author":"Safarpour","year":"2018","journal-title":"Toxicon"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1111\/j.1526-4610.2010.01678.x","article-title":"OnabotulinumtoxinA for Treatment of Chronic Migraine: Pooled Results from the Double-Blind, Randomized, Placebo-Controlled Phases of the PREEMPT Clinical Program","volume":"50","author":"Dodick","year":"2010","journal-title":"Headache"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(14)70251-0","article-title":"Pharmacotherapy for Neuropathic Pain in Adults: A Systematic Review and Meta-Analysis","volume":"14","author":"Finnerup","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_7","first-page":"311","article-title":"Intramuscular Botulinum Toxin A (BtxA) in Complex Regional Pain Syndrome","volume":"14","author":"Kharkar","year":"2011","journal-title":"Pain Physician"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1111\/j.1526-4637.2010.00929.x","article-title":"Botulinum Toxin A (Botox) for Treatment of Proximal Myofascial Pain in Complex Regional Pain Syndrome: Two Cases","volume":"11","author":"Safarpour","year":"2010","journal-title":"Pain Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.toxicon.2019.01.002","article-title":"Intra-Articular Botulinum Toxin Injection in Complex Regional Pain Syndrome: Case Report and Review of the Literature","volume":"159","author":"Bellon","year":"2019","journal-title":"Toxicon"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Lee, Y., Lee, C.J., Choi, E., Lee, P.B., Lee, H.-J., and Nahm, F.S. (2018). Lumbar Sympathetic Block with Botulinum Toxin Type A and Type B for the Complex Regional Pain Syndrome. Toxins, 10.","DOI":"10.3390\/toxins10040164"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1111\/j.1526-4637.2010.00897.x","article-title":"Botulinum Toxin A for Treatment of Allodynia of Complex Regional Pain Syndrome: A Pilot Study","volume":"11","author":"Safarpour","year":"2010","journal-title":"Pain Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.pmrj.2011.12.010","article-title":"Subcutaneous Botulinum Toxin A for the Treatment of Refractory Complex Regional Pain Syndrome","volume":"4","author":"Birthi","year":"2012","journal-title":"PM&R"},{"key":"ref_13","first-page":"215","article-title":"Botulinum Toxin Treatment for Intractable Allodynia in a Patient with Complex Regional Pain Syndrome: A Case Report","volume":"25","author":"Kwak","year":"2020","journal-title":"Neurol. Asia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.pain.2010.04.030","article-title":"Validation of Proposed Diagnostic Criteria (the \u201cBudapest Criteria\u201d) for Complex Regional Pain Syndrome","volume":"150","author":"Harden","year":"2010","journal-title":"Pain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1016\/j.clinph.2008.03.016","article-title":"Recommendations for the Clinical Use of Somatosensory-Evoked Potentials","volume":"119","author":"Cruccu","year":"2008","journal-title":"Clin. Neurophysiol. Off. J. Int. Fed. Clin. Neurophysiol."},{"key":"ref_16","first-page":"108","article-title":"Sympathetic Skin Response: Review of the Method and Its Clinical Use","volume":"105","author":"Kucera","year":"2004","journal-title":"Bratisl. Lek\u00e1rske Listy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.neulet.2016.06.001","article-title":"In-Vivo Comparison of the Neurotoxic Potencies of IncobotulinumtoxinA, OnabotulinumtoxinA, and AbobotulinumtoxinA","volume":"627","author":"Kutschenko","year":"2016","journal-title":"Neurosci. Lett."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1124\/pr.116.012658","article-title":"Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology","volume":"69","author":"Pirazzini","year":"2017","journal-title":"Pharmacol. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5603\/PJNNS.a2021.0027","article-title":"Botulinum Toxin Type-A Preparations Are Not the Same Medications\u2014Basic Science (Part 1)","volume":"55","author":"Car","year":"2021","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8003","DOI":"10.1523\/JNEUROSCI.17-20-08003.1997","article-title":"Specific C-Receptors for Itch in Human Skin","volume":"17","author":"Schmelz","year":"1997","journal-title":"J. Neurosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1126\/science.3966152","article-title":"Coupling of Action Potential Activity between Unmyelinated Fibers in the Peripheral Nerve of Monkey","volume":"227","author":"Meyer","year":"1985","journal-title":"Science"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1097\/00002508-200006001-00004","article-title":"Peripheral Neuropathic Pain: From Mechanisms to Symptoms","volume":"16","author":"Baron","year":"2000","journal-title":"Clin. J. Pain"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"21338","DOI":"10.1016\/S0021-9258(19)36614-1","article-title":"Tetanus Toxin and Botulinum Toxins Type A and B Inhibit Glutamate, Gamma-Aminobutyric Acid, Aspartate, and Met-Enkephalin Release from Synaptosomes. Clues to the Locus of Action","volume":"267","author":"McMahon","year":"1992","journal-title":"J. Biol. Chem."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/0014-2999(89)90229-X","article-title":"Effects of Botulinum A Toxin on Presynaptic Modulation of Evoked Transmitter Release","volume":"164","author":"Nakov","year":"1989","journal-title":"Eur. J. Pharmacol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1526-4610.2004.04007.x","article-title":"Regulation of Calcitonin Gene-Related Peptide Secretion from Trigeminal Nerve Cells by Botulinum Toxin Type A: Implications for Migraine Therapy","volume":"44","author":"Durham","year":"2004","journal-title":"Headache"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1016\/S0006-2952(00)00260-4","article-title":"Capsaicin-Stimulated Release of Substance P from Cultured Dorsal Root Ganglion Neurons: Involvement of Two Distinct Mechanisms","volume":"59","author":"Purkiss","year":"2000","journal-title":"Biochem. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1600-0854.2006.00520.x","article-title":"Traffic of Botulinum Toxins A and E in Excitatory and Inhibitory Neurons","volume":"8","author":"Verderio","year":"2007","journal-title":"Traffic"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.nbd.2012.07.010","article-title":"Reduction of TRPV1 Expression in the Trigeminal System by Botulinum Neurotoxin Type-A","volume":"48","author":"Shimizu","year":"2012","journal-title":"Neurobiol. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/bph.13366","article-title":"Activity of Botulinum Toxin Type A in Cranial Dura: Implications for Treatment of Migraine and Other Headaches","volume":"173","author":"Matak","year":"2016","journal-title":"Br. J. Pharmacol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Marinelli, S., Vacca, V., Ricordy, R., Uggenti, C., Tata, A.M., Luvisetto, S., and Pavone, F. (2012). The Analgesic Effect on Neuropathic Pain of Retrogradely Transported Botulinum Neurotoxin A Involves Schwann Cells and Astrocytes. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0047977"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.nbd.2015.04.011","article-title":"Botulinum Toxin in Migraine: Role of Transport in Trigemino-Somatic and Trigemino-Vascular Afferents","volume":"79","author":"Ramachandran","year":"2015","journal-title":"Neurobiol. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.neuropharm.2013.02.011","article-title":"Involvement of \u03bc-Opioid Receptors in Antinociceptive Action of Botulinum Toxin Type A","volume":"70","author":"Drinovac","year":"2013","journal-title":"Neuropharmacology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s00702-013-1150-6","article-title":"Association of Antinociceptive Action of Botulinum Toxin Type A with GABA-A Receptor","volume":"121","author":"Drinovac","year":"2014","journal-title":"J. Neural Transm."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.neuroscience.2010.11.040","article-title":"The Effect of Botulinum Neurotoxin A on Sciatic Nerve Injury-Induced Neuroimmunological Changes in Rat Dorsal Root Ganglia and Spinal Cord","volume":"175","author":"Mika","year":"2011","journal-title":"Neuroscience"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3389\/fcimb.2017.00141","article-title":"Comparison of the Expression Changes after Botulinum Toxin Type A and Minocycline Administration in Lipopolysaccharide-Stimulated Rat Microglial and Astroglial Cultures","volume":"7","author":"Piotrowska","year":"2017","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.pain.2014.04.027","article-title":"Botulinum Toxin Type A Selectivity for Certain Types of Pain Is Associated with Capsaicin-Sensitive Neurons","volume":"155","author":"Matak","year":"2014","journal-title":"Pain"},{"key":"ref_37","first-page":"347","article-title":"Increased Levels of SV2A Botulinum Neurotoxin Receptor in Clinical Sensory Disorders and Functional Effects of Botulinum Toxins A and E in Cultured Human Sensory Neurons","volume":"4","author":"Yiangou","year":"2011","journal-title":"J. Pain Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3389\/fneur.2014.00098","article-title":"Spinal Central Effects of Peripherally Applied Botulinum Neurotoxin A in Comparison between Its Subtypes A1 and A2","volume":"5","author":"Koizumi","year":"2014","journal-title":"Front. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Datta Gupta, A., Edwards, S., Smith, J., Snow, J., Visvanathan, R., Tucker, G., and Wilson, D. (2022). A Systematic Review and Meta-Analysis of Efficacy of Botulinum Toxin A for Neuropathic Pain. Toxins, 14.","DOI":"10.3390\/toxins14010036"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jpain.2014.11.008","article-title":"Placebo Responses in Long-Standing Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis","volume":"16","author":"Mbizvo","year":"2015","journal-title":"J. Pain"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L","article-title":"Development of an Upper Extremity Outcome Measure: The DASH (Disabilities of the Arm, Shoulder and Hand) [Corrected]. The Upper Extremity Collaborative Group (UECG)","volume":"29","author":"Hudak","year":"1996","journal-title":"Am. J. Ind. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.pain.2003.12.024","article-title":"Development and Validation of the Neuropathic Pain Symptom Inventory","volume":"108","author":"Bouhassira","year":"2004","journal-title":"Pain"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.jpain.2015.02.007","article-title":"Patients\u2019 Impression of Change Following Treatment for Chronic Pain: Global, Specific, a Single Dimension, or Many?","volume":"16","author":"Scott","year":"2015","journal-title":"J. Pain"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/6\/411\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:32:47Z","timestamp":1760139167000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/6\/411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,16]]},"references-count":43,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["toxins14060411"],"URL":"https:\/\/doi.org\/10.3390\/toxins14060411","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,16]]}}}