Rosales Raymond L, Cuffe Lorraine, Regnault Benjamin, Trosch Richard M
Dept. of Neurology and Psychiatry, the Neuroscience Institute, University of Santo Tomas Hospital, Manila, Philippines.
The Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines.
Expert Rev Neurother. 2021 Oct;21(10):1125-1134. doi: 10.1080/14737175.2021.1984230. Epub 2021 Sep 29.
In patients with cervical dystonia (CD), pain is a major contributor to disability and social isolation and is often the main reason patients seek treatment. Surveys evaluating patient perceptions of their CD symptoms consistently highlight pain as a troublesome and disabling feature of their condition with significant impact on daily life and work.
In this article, the authors review the epidemiology, assessment, possible mechanisms and treatment of pain in CD, including a meta-analysis of randomized controlled trial data with abobotulinumtoxinA.
Mechanisms of pain in CD may be muscle-based and non-muscle based. Accumulating evidence suggests that non-muscle-based mechanisms (such as abnormal transmission and processing of nociceptive stimuli, dysfunction of descending pain inhibitory pathways as well as structural and network changes in the basal ganglia, cortex and other areas) may also contribute to pain in CD alongside prolonged muscle contraction. Chemodenervation with botulinum toxin is considered the first-line treatment for CD. Treatment with botulinum toxin is usually effective, but optimization of the injection parameters should include consideration of pain as a core symptom in addition to the motor problems.
在颈部肌张力障碍（CD）患者中，疼痛是导致残疾和社交孤立的主要因素，且常常是患者寻求治疗的主要原因。评估患者对其CD症状看法的调查始终将疼痛视为其病情中一个麻烦且致残的特征，对日常生活和工作有重大影响。
在本文中，作者回顾了CD中疼痛的流行病学、评估、可能机制及治疗方法，包括对阿柏西普肉毒毒素A随机对照试验数据的荟萃分析。
CD中疼痛的机制可能基于肌肉和非肌肉。越来越多的证据表明，除了肌肉长期收缩外，非肌肉机制（如伤害性刺激的异常传递和处理、下行疼痛抑制通路功能障碍以及基底神经节、皮层和其他区域的结构和网络变化）也可能导致CD中的疼痛。肉毒毒素化学去神经支配被认为是CD的一线治疗方法。肉毒毒素治疗通常有效，但注射参数的优化除了考虑运动问题外，还应将疼痛作为核心症状。
