Botulinum Toxin for Diabetic Neuropathic Pain: A Randomized Double-Blind Crossover Trial

We are skeptical of the benefits of botulinum toxin type A (BoNT/A) in treating neuropathic pain.1 We also believe that Apfel's2 accompanying editorial was too positive regarding this study involving only 18 patients. Sleep problems and quality of life scores have nothing in common with results of the visual analog scale (VAS) and these are our patients' major concerns. In addition, the pattern of injections is not related to the areas where our patients complain about pain, including the toes and balls of the feet. Furthermore, data have shown that injection sites followed the pain.3,4 The study would have benefited by having independent funding rather than relying on the largess of Allergan for the BoNT/A. BoNT/A has proven indications, but the drive to expand them is industry-driven and is reminiscent of the marketing strategy of …