The purpose of this study is to determine whether botulinum toxin A is effective in the treatment of neuropathic pain in spinal cord injury patients.

Neuropathic pain remains a significant cause of life quality deterioration. This study includes spinal cord injury patients with refractory chronic neuropathic pain and investigates whether injection with botulinum toxin A improves pain scores.

Inclusion Criteria:

• more than twenty years of age
• paraplegic or tetraplegic due to cervical and thoracic spinal cord injury
• more than 12 months since spinal cord injury and ASIA impairment scale unchanged for more than 6 months
• persistence of neuropathic pain for more than three months or remission and recurrence of neuropathic pain for more than six months
• a pain score of 40mm or more on the visual analogue scale

Exclusion Criteria:

• neuropathic pain caused by confounding factors other than spinal cord injury
• contraindicated for botulinum toxin type A
• a change in pain medication one month prior to study enrollment
• a condition involving neuromuscular junction (Ex. Eaton Lambert disease, myasthenia gravis)
• person who received botulinum toxin type A within three months prior to study enrollment