Smith Howard S, Audette Joseph, Royal Mike A
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Clin J Pain. 2002 Nov-Dec;18(6 Suppl):S147-54. doi: 10.1097/00002508-200211001-00006.
Botulinum toxin is approved for the treatment of muscle overactivity associated with several disorders, such as dystonias. However, control of muscle spasm often results in pain relief as well. Effective relief of pain associated with myofascial pain syndrome provides a model for the use of botulinum toxin to relieve pain associated with other types of soft-tissue syndromes, such as fibromyalgia. Although the mechanisms that trigger the pain in these syndromes vary, recent data suggest that a central neuroplastic mechanism may contribute to many complex pain syndromes. Botulinum toxin therapy may be particularly useful in soft-tissue syndromes that are refractory to traditional treatment with physical therapy, electrical muscle stimulation, and other approaches. Although not used as first-line therapy for pain relief, botulinum toxin may decrease pain long enough for patients to resume more conservative therapy. A primary benefit of treatment with botulinum toxin is its long duration of action. Several studies have demonstrated the efficacy of botulinum toxin types A and B in treating several neuropathic pain disorders. Proper patient selection, injection technique, and dosing are critical to obtaining the best outcomes in managing pain with botulinum toxin. Additional study is needed to better characterize its use for the treatment of pain.
肉毒杆菌毒素已被批准用于治疗与多种疾病相关的肌肉过度活动，如肌张力障碍。然而，控制肌肉痉挛通常也会带来疼痛缓解。有效缓解与肌筋膜疼痛综合征相关的疼痛为使用肉毒杆菌毒素缓解与其他类型软组织综合征（如纤维肌痛）相关的疼痛提供了一个范例。尽管这些综合征中引发疼痛的机制各不相同，但最近的数据表明，一种中枢神经可塑性机制可能与许多复杂的疼痛综合征有关。肉毒杆菌毒素疗法在对传统物理治疗、肌肉电刺激及其他方法治疗无效的软组织综合征中可能特别有用。虽然肉毒杆菌毒素不作为缓解疼痛的一线疗法，但它可能会在足够长的时间内减轻疼痛，使患者能够恢复更保守的治疗。肉毒杆菌毒素治疗的一个主要优点是其作用持续时间长。多项研究已证明A型和B型肉毒杆菌毒素在治疗几种神经性疼痛疾病方面的疗效。正确选择患者、注射技术和剂量对于使用肉毒杆菌毒素治疗疼痛取得最佳效果至关重要。需要进行更多研究以更好地明确其在疼痛治疗中的应用。
