治疗性周围神经阻滞治疗慢性颌面疼痛的叙述性综述。
A Narrative Review of Therapeutic Peripheral Nerve Blocks for Chronic Orofacial Pain Conditions.
出版信息
J Oral Facial Pain Headache. 2022;36(1):49-58. doi: 10.11607/ofph.3017.
AIMS
To provide an analysis of the different therapeutic peripheral nerve blocks (PNBs), as well as their limitations and the related evidence base for their use in chronic orofacial pain (OFP) conditions, excluding migraine and other headache conditions.
METHODS/RESULTS: The evidence base for therapeutic PNBs for chronic OFP is poor and highlights the need for improved research in this area. The diagnostic criteria and interventional PNB definitions and techniques varied between studies. In addition, the placebo effect of a peripheral injection and its resultant bias was rarely considered. Most of the PNB interventions for temporomandibular disorders were for arthrogenous disorders (arthritis and disc entrapment with pain). However, there is emerging evidence for the use of onabotulinum toxin (BTX-A) in trigeminal neuralgia, with four prospective randomized controlled trials (pRCTs), and for postherpetic neuralgia. However, despite high-level evidence for BTX-A in posttraumatic neuropathic pain outside the trigeminal system, there is no evidence for its use for PTNP within the trigeminal system.
CONCLUSION
There may be emerging evidence for treating trigeminal neuralgia with BTX-A injections; however, there is a need for future clinical studies of therapeutic PNBs in orofacial pain conditions.
目的
分析不同的治疗性周围神经阻滞（PNB），以及它们在慢性口腔颌面疼痛（OFP）病症中的应用的局限性和相关证据基础，偏头痛和其他头痛病症除外。
方法/结果：慢性 OFP 治疗性 PNB 的证据基础较差，突出表明需要在该领域进行改进研究。研究之间诊断标准、介入性 PNB 定义和技术存在差异。此外，很少考虑外周注射的安慰剂效应及其由此产生的偏差。大多数颞下颌关节紊乱症的 PNB 干预措施都是针对关节源性疾病（关节炎和伴疼痛的关节盘嵌顿）。然而，在三叉神经痛中使用肉毒杆菌毒素（BTX-A）的证据正在出现，有四项前瞻性随机对照试验（pRCT），以及疱疹后神经痛。然而，尽管 BTX-A 在三叉神经系统以外的创伤后神经性疼痛方面具有高级别证据，但在三叉神经系统内，没有证据表明其可用于治疗 PTNP。
结论
BTX-A 注射治疗三叉神经痛可能有新的证据，但需要对口腔颌面疼痛病症的治疗性 PNB 进行未来的临床研究。
Zotero 插件