Safarpour Yasaman, Jabbari Bahman
Department of Medicine, Division of Nephrology, University of California, Irvine (UCI), CA, USA.
Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
Toxicon. 2018 Jun 1;147:120-128. doi: 10.1016/j.toxicon.2018.01.017. Epub 2018 Feb 1.
This review evaluates the existing level of evidence for efficacy of BoNTs in different pain syndromes using the recommended efficacy criteria from the Assessment and Therapeutic Subcommittee of the American Academy of Neurology. There is a level A evidence (effective) for BoNT therapy in post-herpetic neuralgia, trigeminal neuralgia, and posttraumatic neuralgia. There is a level B evidence (probably effective) for diabetic neuropathy, plantar fasciitis, piriformis syndrome, pain associated with total knee arthroplasty, male pelvic pain syndrome, chronic low back pain, male pelvic pain, and neuropathic pain secondary to traumatic spinal cord injury. BoNTs are possibly effective (Level C -one class II study) for female pelvic pain, painful knee osteoarthritis, post-operative pain in children with cerebral palsy after adductor release surgery, anterior knee pain with vastus lateralis imbalance. There is a level B evidence (one class I study) that BoNT treatment is probably ineffective in carpal tunnel syndrome. For myofascial pain syndrome, the level of evidence is U (undetermined) due to contradicting results. More high quality (Class I) studies and studies with different types of BoNTs are needed for better understanding of the role of BoNTs in pain syndromes.
本综述使用美国神经病学学会评估与治疗小组委员会推荐的疗效标准，评估了肉毒毒素（BoNTs）在不同疼痛综合征中的现有证据水平。对于带状疱疹后神经痛、三叉神经痛和创伤后神经痛，有A级证据（有效）支持BoNT治疗。对于糖尿病性神经病变、足底筋膜炎、梨状肌综合征、全膝关节置换术后疼痛、男性盆腔疼痛综合征、慢性下腰痛、男性盆腔疼痛以及创伤性脊髓损伤继发的神经性疼痛，有B级证据（可能有效）。对于女性盆腔疼痛、疼痛性膝骨关节炎、脑瘫患儿内收肌松解术后的术后疼痛、股外侧肌失衡导致的膝前疼痛，BoNTs可能有效（C级——一项II类研究）。有B级证据（一项I类研究）表明BoNT治疗在腕管综合征中可能无效。对于肌筋膜疼痛综合征，由于结果相互矛盾，证据水平为U（未确定）。需要更多高质量（I类）研究以及使用不同类型BoNTs的研究，以更好地了解BoNTs在疼痛综合征中的作用。
