Kumar Raj
Botulinum Research Center, Institute of Advanced Sciences, Dartmouth, MA 02747, U.S.A.
Neuronal Signal. 2018 Aug 31;2(3):NS20180058. doi: 10.1042/NS20180058. eCollection 2018 Sep.
Botulinum toxin is one of the most potent molecule known to mankind. A neurotoxin, with high affinity for cholinergic synapse, is effectively capable of inhibiting the release of acetylcholine. On the other hand, botulinum toxin is therapeutically used for several musculoskeletal disorders. Although most of the therapeutic effect of botulinum toxin is due to temporary skeletal muscle relaxation (mainly due to inhibition of the acetylcholine release), other effects on the nervous system are also investigated. One of the therapeutically investigated areas of the botulinum neurotoxin (BoNT) is the treatment of pain. At present, it is used for several chronic pain diseases, such as myofascial syndrome, headaches, arthritis, and neuropathic pain. Although the effect of botulinum toxin in pain is mainly due to its effect on cholinergic transmission in the somatic and autonomic nervous systems, research suggests that botulinum toxin can also provide benefits related to effects on cholinergic control of cholinergic nociceptive and antinociceptive systems. Furthermore, evidence suggests that botulinum toxin can also affect central nervous system (CNS). In summary, botulinum toxin holds great potential for pain treatments. It may be also useful for the pain treatments where other methods are ineffective with no side effect(s). Further studies will establish the exact analgesic mechanisms, efficacy, and complication of botulinum toxin in chronic pain disorders, and to some extent acute pain disorders.
肉毒杆菌毒素是人类已知的最具毒性的分子之一。作为一种对胆碱能突触具有高亲和力的神经毒素，它能够有效抑制乙酰胆碱的释放。另一方面，肉毒杆菌毒素被用于治疗多种肌肉骨骼疾病。尽管肉毒杆菌毒素的大部分治疗效果归因于暂时的骨骼肌松弛（主要是由于抑制乙酰胆碱的释放），但人们也在研究其对神经系统的其他影响。肉毒杆菌神经毒素（BoNT）在治疗方面的研究领域之一是疼痛治疗。目前，它被用于治疗多种慢性疼痛疾病，如肌筋膜综合征、头痛、关节炎和神经性疼痛。尽管肉毒杆菌毒素在疼痛治疗中的作用主要归因于其对躯体和自主神经系统中胆碱能传递的影响，但研究表明，肉毒杆菌毒素还可能通过对胆碱能伤害性感受和抗伤害性感受系统的胆碱能控制产生影响而带来益处。此外，有证据表明肉毒杆菌毒素还能影响中枢神经系统（CNS）。总之，肉毒杆菌毒素在疼痛治疗方面具有巨大潜力。对于其他方法无效且无副作用的疼痛治疗，它可能也有用。进一步的研究将确定肉毒杆菌毒素在慢性疼痛疾病以及在一定程度上急性疼痛疾病中的确切镇痛机制、疗效和并发症。
