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In the experience of the authors of the present publication, local botulinum toxin application might be considered in single individuals with pain refractory to maximized oral or transdermal treatment, especially in case of on- and off dystonia, muscular pain trigger points, painful myotonus, spasms in the esophagus, pylorus, anal sphincter or hyperactive bladder [29]

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Avoid contact with the eyes and discontinue use if irritation occurs

Hence, more directed in vitro studies are required to establish kratom toxicity