Benecke R, Dressler D, Kunesch E, Probst T
Klinik für Neurologie und Poliklinik, Universität Rostock.
Schmerz. 2003 Dec;17(6):450-8. doi: 10.1007/s00482-003-0263-5.
The analgesic effects of botulinum toxin (BTX) have been discussed controversially due to substantial placebo effects and flaws in the study designs used. Additionally, pathophysiological concepts of pain and the specific analgesic mechanisms of BTX remain largely unclear. Apart from pain reduction through the well-documented effects of BTX at the neuromuscular endplate, additional analgesic mechanisms, including other synaptic and local effects, have been suggested. Currently, BTX can be recommended for pain treatment in dystonia and spasticity. In myofascial pain syndromes, pain relief by BTX injections has been reported, but definite proof according to evidence-based medicinal criteria is still lacking. In fibromyalgia, there seems to be no analgesic effect. The role of BTX in pain therapy is likely to increase in the future.
由于存在显著的安慰剂效应以及所用研究设计的缺陷，肉毒杆菌毒素（BTX）的镇痛效果一直存在争议。此外，疼痛的病理生理概念以及BTX的具体镇痛机制在很大程度上仍不明确。除了通过BTX在神经肌肉终板的充分记录的效应来减轻疼痛外，还提出了其他镇痛机制，包括其他突触和局部效应。目前，BTX可推荐用于治疗肌张力障碍和痉挛性疼痛。在肌筋膜疼痛综合征中，已有报道称BTX注射可缓解疼痛，但根据循证医学标准的明确证据仍然缺乏。在纤维肌痛中，似乎没有镇痛作用。BTX在疼痛治疗中的作用未来可能会增加。
