Physical and Rehabilitation Medicine Department, Alicante University General Hospital, C/Pintor Baeza s/n, 03010 Alicante, Spain.
Evid Based Complement Alternat Med. 2013;2013:381459. doi: 10.1155/2013/381459. Epub 2013 Feb 19.
Introduction. Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results. Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS. Results and Discussion. Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies.
引言。肉毒杆菌毒素抑制乙酰胆碱 (ACh) 的释放，并可能阻断某些伤害性神经递质。有人认为，肌筋膜触发点 (MTrP) 的发展与 ACh 的过度释放有关，以增加敏化伤害感受器的数量。尽管肉毒杆菌毒素已在许多临床试验中被用于治疗肌筋膜疼痛综合征 (MPS)，但结果却相互矛盾。本文旨在确定可能导致这些结果差异的变异性来源。
材料和方法。我们对 MPS 的临床试验和系统评价进行了内容分析。
结果与讨论。研究中的差异来源可在诊断和选择标准、注射的肌肉、注射技术、注射的触发点数量、使用的肉毒毒素剂量、对照组的治疗、结局测量和随访时间等方面找到。与颈部和背部疼痛相关的 MPS 中肉毒杆菌毒素 A 的疗效存在矛盾结果，这使得无法推荐或拒绝这种治疗方法。有证据表明，肉毒毒素在特定的肌筋膜区域（如梨状肌综合征）可能有用。对于对其他肌筋膜注射疗法无反应的难治性 MPS 患者，它也可能有用。
