Jeynes Louise C, Gauci Charles A
The Boyle Department of Anesthesia, St. Bartholomew's Hospital, London, UK.
Pain Pract. 2008 Jul-Aug;8(4):269-76. doi: 10.1111/j.1533-2500.2008.00202.x. Epub 2008 May 23.
A significant proportion of chronic pain is of musculoskeletal origin. Botulinum toxin (BTX) has been successfully used in the treatment of spasmodic torticollis, limb dystonia, and spasticity. Investigators have, thus, become interested in its potential use in treating many chronic pain conditions. Practitioners have used BTX, outside the product license, in the treatment of refractory myofascial pain syndrome and neck and low back pain (LBP). This article reviews the current evidence relating to chronic pain practice. There is evidence supporting the use of both BTX type A and type B in the treatment of cervical dystonias. The weight of evidence is in favor of BTX type A as a treatment in: pelvic pain, plantar fasciitis, temporomandibular joint dysfunction associated facial pain, chronic LBP, carpal tunnel syndrome, joint pain, and in complex regional pain syndrome and selected neuropathic pain syndromes. The weight of evidence is also in favor of BTX type A and type B in piriformis syndrome. There is conflicting evidence relating to the use of BTX in the treatment whiplash, myofascial pain, and myogenous jaw pain. It does appear that BTX is useful in selected patients, and its duration of action may exceed that of conventional treatments. This seems a promising treatment that must be further evaluated.
相当一部分慢性疼痛源于肌肉骨骼系统。肉毒杆菌毒素（BTX）已成功用于治疗痉挛性斜颈、肢体肌张力障碍和痉挛。因此，研究人员开始对其在治疗多种慢性疼痛病症中的潜在用途产生兴趣。从业者已在产品许可范围之外使用BTX治疗难治性肌筋膜疼痛综合征以及颈痛和腰痛（LBP）。本文综述了与慢性疼痛治疗相关的现有证据。有证据支持A型和B型肉毒杆菌毒素用于治疗颈部肌张力障碍。证据倾向于A型肉毒杆菌毒素用于治疗：盆腔疼痛、足底筋膜炎、与颞下颌关节功能障碍相关的面部疼痛、慢性腰痛、腕管综合征、关节疼痛，以及复杂性区域疼痛综合征和某些神经性疼痛综合征。证据也倾向于A型和B型肉毒杆菌毒素用于治疗梨状肌综合征。关于BTX用于治疗挥鞭样损伤、肌筋膜疼痛和肌源性颌面部疼痛存在相互矛盾的证据。看起来BTX对部分患者有用，其作用持续时间可能超过传统治疗。这似乎是一种有前景的治疗方法，必须进一步评估。
