Which of the following medications is NOT typically used for neuropathic pain in MS?

Botulinum toxin is not typically used for neuropathic pain in multiple sclerosis (MS). While it is an effective treatment for certain conditions, such as chronic migraines and specific muscle spasticity issues, its application for neuropathic pain has not been established as standard practice. The use of botulinum toxin for neuropathic pain lacks strong evidence and is not commonly included in treatment guidelines for managing pain associated with MS.

In contrast, the other medications listed have established roles in the management of neuropathic pain. Tramadol is an opioid analgesic that can provide relief for various types of pain, including neuropathic pain. Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is approved for the treatment of chronic pain conditions, including those with a neuropathic component. The capsaicin patch, which works by depleting substance P in the nerve endings, can also be effective for treating localized neuropathic pain. Thus, choosing botulinum toxin as the answer correctly identifies it as the medication not typically used for neuropathic pain in MS.