Bellon Giulia, Venturin Andrea, Masiero Stefano, Del Felice Alessandra
Department of Physical and Rehabilitation Medicine, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
Department of Physical and Rehabilitation Medicine, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
Toxicon. 2019 Mar 1;159:41-44. doi: 10.1016/j.toxicon.2019.01.002. Epub 2019 Jan 17.
Complex regional pain syndrome (CRPS) is characterized by hyperalgesia, autonomic and trophic alterations of bones, muscles and skin. It is supported by neurogenic inflammation and impairment of sympathetic nervous system. Botulinum Toxin (BTX) is an option for the management of pain, with level B evidence of efficacy in neuropathic, joint and myofascial pain syndrome. We report a case of CRPS treated with intra articular injection of BTX-A (IaBI). BTX-A 100 U in 2 cc Na Cl 0,9% was injected into the gleno-humeral joint. Visual analogue scale (VAS) pain score and McGill Pain Questionnaire (MPQ) were administered at T0 (baseline), T1 (one month after IaBI) and T2 (four months after IaBI). Autonomic and trophic skin disorders were clinically monitored. Pain decreased at T1, with a lasting effect at T2, associated with improvement of range of motion (ROM). No improvement in terms of autonomic and trophic skin disorders were reported neither at T1 nor T2. These findings support a possible antinociceptive role of BTX-A in the management of CRPS pain related to inhibition of pain neurotransmitters release. A literature revision of IaBI is provided.
复杂性区域疼痛综合征（CRPS）的特征为痛觉过敏、骨骼、肌肉和皮肤的自主神经及营养改变。它由神经源性炎症和交感神经系统损伤所支持。肉毒毒素（BTX）是一种治疗疼痛的选择，在神经性、关节性和肌筋膜疼痛综合征方面有B级疗效证据。我们报告一例采用关节内注射A型肉毒毒素（IaBI）治疗的CRPS病例。将100单位A型肉毒毒素溶于2毫升0.9%氯化钠注射液中注入肩肱关节。在T0（基线）、T1（IaBI后1个月）和T2（IaBI后4个月）时进行视觉模拟量表（VAS）疼痛评分和麦吉尔疼痛问卷（MPQ）评估。对自主神经和营养性皮肤疾病进行临床监测。疼痛在T1时减轻，在T2时持续有效，同时伴有活动范围（ROM）的改善。在T1和T2时均未报告自主神经和营养性皮肤疾病有改善。这些发现支持A型肉毒毒素在治疗与抑制疼痛神经递质释放相关的CRPS疼痛方面可能具有抗伤害感受作用。本文还提供了IaBI的文献综述。
