Figure 2.

Post-surgical and post-radiation pain treated with BoNT. Example of two patients. From Jabbari B. Botulinum Toxin Treatment in Pain Disorders. Springer, New York 2015. Printed with permission from the publisher. (A) A 47-year-old man had undergone right neck dissection and radiotherapy for cancer of the tongue and cervical adenopathy 6 years prior to visiting the Yale clinic. A year following surgery and radiotherapy, severe pain (VAS 9–10, both sharp and deep) developed over the right side of the neck which was mostly felt below the mandible and anterior to the angle of the jaw. Injecting onabotulinumtoxinA into the areas designated by X on the figure, (30, 30, and 20 units) reduced the pain significantly (VAS 1) within a week after injection. He remained responsive and satisfied (assessed by PGIC) receiving injections every 4–6 months over 7 years of follow-up. (B) A 48-year old man with squamous cell carcinoma of piriform sinus had supraglottic laryngectomy. Two years following neck dissection and radiotherapy, he developed severe pain (VAS 9) over the left side of the neck. The pain was deep as well as sharp and superficial. Injection of onabotulinumtoxinA, 20 units into each superficial pain region (Xs around the jaw) and 30 units into nearby posteriorly located muscles (splenius and trapezius) designated by X reduced the pain to VAS 0–1 level. The total dose was 200 units. The patient enjoyed pain relief with repeat injections over the 3 years of follow-up. Drawings courtesy of Damoun Safarpour M.D.