Perineural Injections of Incobotulinumtoxin-A for Diabetic Neuropathic Pain of the Lower Extremities

Inclusion Criteria: * Are 18 years or older * Are diagnosed with diabetes type I or II * Score 3 or above on the Doleur Neuropathique 4 interview section * Suffer from pain of the lower extremities which * is considered by the participant as their dominant overall dominant pain * is rated at least 4 out of 10 of the NRS pain scale in both legs (on average over the past 7 days) * is present in both feet, roughly symmetrically. * has been present for at least 6 months * Show sensory deficits and/or allodynia or hyperalgesia in the painful area, consistent with the IASP definition of probable chronic neuropathic pain40. * Are in a stable analgesic treatment regime for at least 1 month prior to inclusion and for the duration of the study * Are using an approved, safe contraceptive (for premenopausal women) * Speak, read, and understand Danish Exclusion Criteria: * • Have a known allergy or hypersensitivity to BonT-A * Have been treated with BonT in the last 6 months. * Are diagnosed with myasthenia, Eaton-Lambert syndrome, or amyotrophic lateral sclerosis * Have a known malignant condition * Have an ongoing infection in the area of injection * Are expecting to change their pain medication during the study period * Have been treated with topical agents such as capsaicin or lidocaine products in the affected areas for at least 3 months prior to inclusion * Are diagnosed with a competing cause of central or peripheral neuropathic pain, or other painful chronic conditions of the lower extremities, such as: * spinal stenosis * claudication * previous trauma or nerve injury * cancer related pain * Have a psychiatric condition that affects their completion of the study, as assessed by the investigator. * Are active abusers of alcohol or illegal substances * Are using or receiving treatment with cannabis products of any kind * Are pregnant or planning pregnancy during the study period * Score more than 12 on the Charlson Comorbidity Index