Botulinum Toxin: Pharmacology and Therapeutic Roles in Pain States

Curr Pain Headache Rep. 2016 Mar;20(3):15. doi: 10.1007/s11916-016-0545-0.


Botulinum toxin, also known as Botox, is produced by Clostridium botulinum, a gram-positive anaerobic bacterium, and botulinum toxin injections are among the most commonly practiced cosmetic procedures in the USA. Although botulinum toxin is typically associated with cosmetic procedures, it can be used to treat a variety of other conditions, including pain. Botulinum toxin blocks the release of acetylcholine from nerve endings to paralyze muscles and to decrease the pain response. Botulinum toxin has a long duration of action, lasting up to 5 months after initial treatment which makes it an excellent treatment for chronic pain patients. This manuscript will outline in detail why botulinum toxin is used as a successful treatment for pain in multiple conditions as well as outline the risks associated with using botulinum toxin in certain individuals. As of today, the only FDA-approved chronic condition that botulinum toxin can be used to treat is migraines and this is related to its ability to decrease muscle tension and increase muscle relaxation. Contraindications to botulinum toxin treatments are limited to a hypersensitivity to the toxin or an infection at the site of injection, and there are no known drug interactions with botulinum toxin. Botulinum toxin is an advantageous and effective alternative pain treatment and a therapy to consider for those that do not respond to opioid treatment. In summary, botulinum toxin is a relatively safe and effective treatment for individuals with certain pain conditions, including migraines. More research is warranted to elucidate chronic and long-term implications of botulinum toxin treatment as well as effects in pregnant, elderly, and adolescent patients.

Keywords: Botulinum toxin; Headache; Neuropathic pain; Non-traditional pain management; Pain.

Publication types

  • Review

MeSH terms

  • Acetylcholine / metabolism
  • Botulinum Toxins, Type A / pharmacology
  • Botulinum Toxins, Type A / therapeutic use*
  • Chronic Pain / drug therapy*
  • Headache Disorders / drug therapy*
  • Headache Disorders / physiopathology
  • Humans
  • Injections, Intramuscular
  • Neuromuscular Agents / pharmacology
  • Neuromuscular Agents / therapeutic use*
  • Pain Measurement
  • Practice Guidelines as Topic
  • Treatment Outcome
  • Trigeminal Nerve / drug effects*
  • Trigeminal Nerve / physiopathology


  • Neuromuscular Agents
  • Botulinum Toxins, Type A
  • Acetylcholine