Lessard Lucie, Bartow Matthew J, Lee James, Diaz-Abel Julian, Tessler Oren E S
Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, La.
Plast Reconstr Surg Glob Open. 2018 Oct 16;6(10):e1847. doi: 10.1097/GOX.0000000000001847. eCollection 2018 Oct.
Complex regional pain syndromes (CRPS) is a disease that is poorly understood. It is a chronic pain syndrome characterized by sympathetic disruptions as well as CNS sensitization. Botulinum Toxin-A has been shown to have efficacy in Raynaud's as well as other neuropathic pain disorders. Perhaps BTX-A warrants experimentation in the treatment of CRPS.
Patients with CRPS refractory to 2 or more regional sympathetic nerve blocks in 2007 were included in the study. Patient's were asked to rank their initial pain on a visual analog scale of 0 to 10 (10 being the worst pain). "Tenderness maps" were marked on patient's areas of most pain in 1 by 1 centimeter grids. Each box on the grid was injected with 10 IU of BTX-A after nerve blocks with 1% lidocaine. Treatment sessions occured on a monthly basis with VAS pain scores being re-assessed immediately before the new treatment. Test, linear regression, and Cohen's D-test were used to analyze the correlation of the data.
Study sample was 20 patients. Etiology of CRPS was 6 amputations, 4 crush injuries, 4 penetrating injuries, and 2 lacerations. Average pain reduction on VAS scale achieved was 2.05 points. Average percentage pain reduction was 22.94%. Cohen's D Test also showed a meaningful difference with a score of 1.01. Linear regression R2 = 0.491. Maximum pain reduction, on average, was achieved by treatment 9.
Despite the esoteric etiology of CRPS, BTX-A has a well-demonstrated mechanism of effect. BTX-A should be further explored as a treatment modality for CRPS.
复杂性区域疼痛综合征（CRPS）是一种了解甚少的疾病。它是一种慢性疼痛综合征，其特征为交感神经功能紊乱以及中枢神经系统致敏。肉毒杆菌毒素A已被证明在雷诺氏病以及其他神经性疼痛疾病中具有疗效。或许肉毒杆菌毒素A值得在CRPS的治疗中进行试验。
2007年纳入了对2次或更多次区域交感神经阻滞治疗无效的CRPS患者进行研究。要求患者在0至10的视觉模拟量表上对其初始疼痛进行评分（10表示最严重的疼痛）。在患者疼痛最严重的区域以1厘米×1厘米的网格标记“压痛图”。在使用1%利多卡因进行神经阻滞后，在网格的每个方格中注射10国际单位的肉毒杆菌毒素A。治疗疗程每月进行一次，在每次新治疗前立即重新评估视觉模拟量表疼痛评分。使用检验、线性回归和科恩D检验来分析数据的相关性。
研究样本为20名患者。CRPS的病因包括6例截肢、4例挤压伤、4例穿透伤和2例撕裂伤。视觉模拟量表上平均疼痛减轻2.05分。平均疼痛减轻百分比为22.94%。科恩D检验也显示出有意义的差异，得分为1.01。线性回归R2 = 0.491。平均而言，第9次治疗时疼痛减轻最大。
尽管CRPS的病因晦涩难懂，但肉毒杆菌毒素A具有已得到充分证明的作用机制。肉毒杆菌毒素A应作为CRPS的一种治疗方式进行进一步探索。
