Beyond Conventional Analgesics: Updated Evidence Supporting Botulinum Toxin Type A for-Neuralgia Management

Background: Neuralgia is a chronic neuropathic pain condition characterized by recurrent paroxysms of severe pain that are often refractory to conventional pharmacological therapies. Botulinum toxin type A (BTX-A) has emerged as a promising adjunctive treatment due to its analgesic and neuromodulatory properties. Objective: Evidence from randomized controlled trials (RCTs) remains heterogeneous, with variability in dosage, injection protocols, and follow-up duration. In addition, prior meta-analyses lacked detailed subgroup analyses, and several RCTs combined BTX-A with concomitant long-term analgesics, obscuring its independent therapeutic effect. This study aimed to provide a comprehensive synthesis of the efficacy and safety of BTX-A monotherapy for neuralgia, while permitting the use of acute analgesics (PROSPERO registration: CRD420251042926). Methods: statistic. Prespecified subgroup analyses were conducted based on dosage and follow-up duration. Results: Seven RCTs encompassing 368 participants were included. Compared with placebo or standard therapy, BTX-A significantly reduced pain intensity (VAS), attack frequency, and rescue analgesic use, while improving sleep quality, quality of life (QoL), and patient global impression of change (PGIC). Subgroup analysis revealed that low-dose regimens (