Schwarzer A, Mäcken T, Enax-Krumova E K
Abteilung für Schmerzmedizin, BG Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, BG Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, Deutschland.
Schmerz. 2023 Aug;37(4):297-307. doi: 10.1007/s00482-023-00730-9. Epub 2023 Jun 26.
Botulinum toxin has been used for decades in the treatment of a variety of painful diseases. Botulinum toxin not only blocks neuromuscular transmission, but also the secretion of neuropeptides, such as substance P, glutamate and calcitonin gene-related peptide (CGRP) and thus inhibits neurogenic inflammation. In addition, it has a modulatory pain-relieving effect via retrograde transport into the central nervous system. In addition to approval for the treatment of dystonia or spasticity, onabotulinum toxin A is also approved for the prophylaxis of chronic migraine if the oral prophylactic migraine medication has had an insufficient effect or has not been tolerated. In addition, botulinum toxin is also recommended in guidelines as a third-line treatment for neuropathic pain, but in Germany this is an off-label application. This article provides an overview of the current clinically relevant areas of application of botulinum toxin in the field of pain medicine.
肉毒杆菌毒素已被用于治疗各种疼痛性疾病数十年。肉毒杆菌毒素不仅能阻断神经肌肉传递，还能抑制神经肽的分泌，如P物质、谷氨酸和降钙素基因相关肽（CGRP），从而抑制神经源性炎症。此外，它通过逆行运输进入中枢神经系统，具有调节性止痛作用。除了被批准用于治疗肌张力障碍或痉挛外，A型肉毒毒素如果口服预防性偏头痛药物效果不佳或无法耐受，也被批准用于预防慢性偏头痛。此外，肉毒杆菌毒素在指南中也被推荐作为神经性疼痛的三线治疗方法，但在德国这属于超适应症用药。本文概述了肉毒杆菌毒素在疼痛医学领域目前临床相关的应用领域。
