Freund Brian J, Schwartz Marvin
The Crown Institute, Toronto, Ontario, Canada.
Clin J Pain. 2002 Nov-Dec;18(6 Suppl):S163-8. doi: 10.1097/00002508-200211001-00008.
Whiplash-associated disorders (WADs) occur as a result of trauma and are often due to motor vehicle accidents and sports injuries. Cervical injury is attributed to rapid extension followed by neck flexion. The exact pathophysiology of WAD is uncertain but probably involves some degree of aberrant muscle spasms and may produce a wide range of symptoms. Initial treatment of pain associated with whiplash usually includes oral medications, such as muscle relaxants and nonsteroidal anti-inflammatory drugs. However, these agents are limited by potential systemic adverse effects. Some patients with chronic WAD may benefit from radiofrequency neurotomy. A new approach to treatment is the use of botulinum toxin, which acts to reduce muscle spasms. Type A toxin (Botox) has been studied in small trials of patients with WAD and has generally been found to relieve pain and improve range of motion. In addition, recent preliminary data from a small trial showed that type B toxin (Myobloc) produced almost immediate pain relief for most patients with post-whiplash headache. Although botulinum toxin has not been evaluated in large long-term trials, these initial data are promising and suggest a role for this agent in the treatment of WAD. Additional study is needed to identify the subset of patients with WAD who are most likely to respond to treatment with botulinum toxin.
挥鞭样损伤相关疾病（WADs）是由创伤引起的，通常归因于机动车事故和运动损伤。颈椎损伤是由于颈部快速伸展后接着屈曲所致。WAD的确切病理生理学尚不确定，但可能涉及一定程度的异常肌肉痉挛，并可能产生广泛的症状。与挥鞭样损伤相关疼痛的初始治疗通常包括口服药物，如肌肉松弛剂和非甾体类抗炎药。然而，这些药物存在潜在的全身不良反应限制。一些慢性WAD患者可能从射频神经切断术中获益。一种新的治疗方法是使用肉毒杆菌毒素，其作用是减轻肌肉痉挛。A型毒素（保妥适）已在WAD患者的小型试验中进行研究，总体上发现其可缓解疼痛并改善活动范围。此外，一项小型试验的近期初步数据显示，B型毒素（迈保生）对大多数挥鞭样损伤后头痛患者几乎可立即缓解疼痛。尽管肉毒杆菌毒素尚未在大型长期试验中进行评估，但这些初始数据很有前景，并表明该药物在WAD治疗中具有一定作用。需要进一步研究以确定WAD患者中最可能对肉毒杆菌毒素治疗产生反应的亚组。
