Abstract Details

Title The First Reported Successful Treatment of Intractable Burning Pain in Erythromelalgia Using OnabotulinumtoxinA: A Case Report

Topic Peripheral Nerve

Presentation(s) P01 - (-)

Poster/Presentation
Number 144

Objective

Background BACKGROUND: A patient with intractable burning pain of legs and face from sporadic erythromelalgia failed to respond to or had unacceptable adverse reactions to multiple treatments, including anti-convulsants, the gabapentinoids,GABA agonists, analgesics, NMDA inhibitors. Topical lidocaine gave partial relief.The patient then developed excruciating, unilateral upper-extremity burning pain that did not respond to any treatment. This change led to a trial of BoNTA, based on the successful outcome of treatment of migraine headache and trigeminal neuralgia. The intention was to block peripheral neurotransmitter release.

Design/Methods DESIGN/METHODS: Treatment: BoNTA was administered 5 times over 7 months by subcutaneous injection in the left upper extremity on days 0, 44, 121 194 and 216 as follows (BoNTA units): the left upper extremity 40, 80, 85, 81 and 16 units respectively.

Results RESULTS: Pain reduction occurred 1-10 days after injection on each occasion. Pain was completely relieved in the left upper extremity (no pain at all) for 2 weeks after the 1st injection, for 3 weeks after the 2nd injection, for 9 weeks after the 3rd injection, and remained completely relieved 5 weeks after the 4th injection. Adverse Effects: transient weakness of wrist and finger extension.

Conclusions CONCLUSIONS: This is the first report of successful BoNTA treatment of intractable burning pain in erythromelalgia when conventional treatment failed. The mechanism of action may be the blockage of neurotransmitter release from peripheral nerve, but is not known for certain.

Authors/Disclosures
Robert Gerwin, MD, FAAN (Retired) PRESENTER	No disclosure on file
	No disclosure on file

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