Human response to unintended intrathecal injection of botulinum toxin

Pain Med. 2011 Jul;12(7):1094-7. doi: 10.1111/j.1526-4637.2011.01135.x. Epub 2011 May 31.


Objective: Describe the first reported human intrathecal (IT) botulinum toxin injection.

Design: Case report.

Setting and patients: We report here the sequelae to an unintended IT injection of botulinum toxin type B (BTB) in a 60-year-old woman with chronic back pain.

Results: Following the IT administration of BTB, the patient experienced the onset of symmetric ascending stocking distribution painful dysesthesias, which persisted for approximately 6 months before receding. Objective neurologic deficits were not appreciated, and analgesic effects were prominently absent.

Conclusions: Analgesic actions of botulinum toxins in animals and in humans have led to speculation that IT botulinum toxin might exert significant analgesic effects. The unusual and unexpected subsequent clinical course, neurologic sequelae, dysesthesias, and absence of analgesia suggest that botulinum toxin will not be a therapeutic modality to treat pain as proposed by those studying botulinum toxin in animal models.

Publication types

  • Case Reports

MeSH terms

  • Animals
  • Back Pain / drug therapy*
  • Botulinum Toxins / adverse effects*
  • Botulinum Toxins / therapeutic use*
  • Chronic Disease
  • Female
  • Humans
  • Injections, Spinal / adverse effects*
  • Middle Aged


  • Botulinum Toxins