Ağrı tedavisinde botulinum toksini tip A kullanımı

Botulinum toksin tip A (BTX-A), iskelet veya düz kas aşırı aktivitesine bağlı olduğu düşünülen çeşitli hastalıklarda klinikte te-davi amaçlı kullanılmaktadır. BTX-A' nın, blefarospazm, spazma bağlı tortikollis ve fasiyel spazm gibi distoni ile seyreden çeşitli durumların tedavisinde etkinliği gösterilmiştir. Aşırı kas aktivitesi ve spazm tedavisinin yanısıra BTX-A, servikal distoni, akalazya ve rektal fissure bağlı ağrıları da azaltır. Botulinum toksini, presinaptik kolinerjik sinir uçlarına geri dönüşümsüz bağlandıktan sonra, asetilkolin salınımını engelleyerek uzun süreli kas gevşemesi ile sonuçlanır ve kas gevşemesi, sinir uçlarının rejenerasyonu tamamlanincaya kadar sürer. Yapılan çalışmalar Botulinum toksin tip A'nın kas spazmına bağlı kronik sırt ağrısının tedavisinde yararlı olacağını düşündürmektedir. Bu derlemede, botoksun tarihsel gelişimi, kullanım endikasyonları, kontrendikasyonları, çeşitli hastahklardaki kullanım dozu, etki mekanizması ve başağrısı, miyofasiyal ağrı, başarısız bel cerrahisi sendromu gibi ağrı yaratan çeşitli hastalıkların tedavisindeki kullanımına değinilmiştir.

Anahtar Kelimeler:

Ağrı, Yüz ağrısı, Botulinum toksini tip A, Baş ağrısı

The use of botulinum toxin type A for pain management

Botulinum toxin type A (BTX-A) has been used clinically for a number of disorders believed to be due to overactive striated or smooth muscles. Bo tulünüm toxin has been shown to be effective for the treatment of various dystonic conditions such as blepharospasm, spasmodic torticollis, spasmodic dysphonia, and facial spasm. In addition to reducing muscle hyperactivity and spasm, BTX-A treatment often reduces the pain associated with cervical dystonia, achalasia, and rectal fissures. After irreversibly binding to presynaptic cholinergic nerve terminals, botulinum toxin prevents the release of acetylcholine, resulting in sustained muscle relaxation, which lasts until regeneration (reinnervation) of the nerve terminals is accomplished. Prelimi-nary evidence suggests that it may also be beneficial in the treatment of chronic low back pain associated with muscle spasm. This review discusses the historical development of botox, its indications, contra-indications and side effects, the doses prescribed for various disorders, the mechanism of action and the use of botox in the treatment of pain conditions including headache, myofascial pain, and failed back surgery syndrome.

Keywords:

Pain, Facial Pain, Botulinum Toxin Type A, Headache,

PDF

___

1. Wells C. Rationale for use of botulinum toxin type A in pain therapy. In: Botulinum toxin type A presentations at the 2nd World Congress of the World Institute of Pain, Istanbul, Turkey, 27-30 June 2001: 2-4.
2. Jankovic J, Brin ME Botulinum toksin: historical perspective and potential new indications. Muscle Nerve 1997, 20(suppl):S129-45.
3. Arnon SS, Schecter R, Inglesby TV, et al. Botulinum toksin as a biological weapon: medical and public health management. JAMA 2001,285:1059-70.
4. Coffield JA, Considine RB, Simpson LL. The site and mechanism of action of botulinum neurotoxin. In: Jankovic J, Hallet M. (eds). Therapy with botulinum toxin. New York: Marcel Dekker, Inc., 1994:3-14.
5. Jankovic J, Brin ME Therapeutic uses of botulinum toxin. N Engl JMed 1991; 324:1186-94.
6. Childers MK, Wilson DJ, Simison D. Use of Botulinum toxin type A in Pain Management. In: Childers MK. (ed). Use of botulinum toxin, type A in pain management: a clinician's guide. Columbia : Book Masters, Inc 1999: 1-4.
7. Greene P, Kang U, Fahn S, Brin M, Moskowitz C, Flaster E.. Double blind placebo controlled trial of botulinum toxin injections for the treatment of spasmodic torticollis. Neurology 1990; 40: 1213-8.
8. Anonymous. Training guidelines for the use of botulinum toxin for the treatment of neurologic disorders. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 1994; 44:2401-3.
9. Foster L, Clapp L, Erickson M, Jabbari B. Botulinum toxin A and chronic low back pain. A randomized,-double-blind study. Neurology 2001; 56(10): 1290-3.
10. De Andres J. Clinical experience with botulinum toxin type A in back pain: a European perspective. In: Botulinum toxin type A presentations at the 2nd World Congress of the World Institute of Pain, Istanbul, Turkey, 27-30 June 2001: 5-7.
11. Royal M. Clinical experience with botulinum toxin type A in back pain: a US perspective. In: Botulinum toxin type A presentations at the 2nd World Congress of the World Institute of Pain, Istanbul, Turkey, 27-30 June 2001: 7-9.
12. ThungaR. Botulinum toxin for myofascial pain syndrome. In: Essentials of Pain Medicine and Regional Anesthesia. Churchill Livingstone, Philadelphia 1999; 92-5.
13. Mellanby J. Comparative activities of tetanus and botulinum toxins. Neuroscience 1984; 11: 16-23.
14. De Paiva A, Ashton A, Foran P, Schiavo G, Montecucco C, Doly J. Botulinum like type B and tetanus toxins fulfills criteria for being a zinc-dependent protease. J Neurochem 1993; 61: 2338-41.
15. Brin MF. Spasticity: Etiology, Evaluation, Management, and the Role of Botulinum Toxin Type A. Muscle Nerve 1997; 20 (Suppl 6): S208-20.
16. Greene P, Fahn S. Development of antibodies to Botulinum Toxin Type A in patients with torticollis treated with injections of Botulinum Toxin Type A. In: Das Grupta BR (ed). Botulinum and Tetanus Neurotoxins: Neurotransmisson and Biomedical Aspects. New York, Plenum Press, 1993: 651-4.
17. Jankovich J, Schwartz K, Donovan DT. Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystoniâs and hemifacial spasm. J Neurol Neurosurg Psychiatry 1990; 53: 633-9.
18. Dressier D. Basic principles of botulinum toxin therapy. Botulinum toxin therapy. Georg Thieme Verlag, Stuttgart, Germany, 2000: 1-36.
19. Mathew NT, Kaup AO. The use of botulinum toxin type A in headache treatment. Current treatment options in neurology 2002; 4:365-73.
20. Brin MF, Fahn S, Moskowitz C, Friedman A, Shale HM, et al. Localized injections of botulinum toxin for the treatment of focal dystonia and hemifacial spasm. Advances in Neurology 1988; 50:599-608.
21. Evers S, Rahmann A, Vollmer-Haase J and Hussted T. Treatment of headache with botulinum toxin A-a review according to evidence-based medicine criteria. Cephalalgia, 2002; 22: 699-710.
22. Aoki KR. Pharmacology and immunology of botulinum toxin serotypes. J Neurol 2001; 248 (Suppl): I/3-I/10.
23. Schnider P, Moraru E, Vigl M, Wober C, et al. Physical therapy and adjunctive botulinum toxin type A in the treatment of cervical headache: a double-blind, randomised, placebo-controlled study. J Headache Pain 2002; 3: 93-9.
24. Jankovich J, Schwartz K. Botulinum toxin injections for cervical dystonia. Neurology 1990; 40: 277-80.
25. Relja M. Treatment of tension-type headache by local injection of botulinum toxin. Eur J Neurol 1997; 4 (Suppl):Sl-73.
26. Robbins L. Botulinum toxin for cluster headache. 6 cases (abstract). Cephalalgia 2001; 21:499.
27. Gobel H, Heinze A, Heinze K. Botulinum toxin A in the treatment of chronic paroxysmal hemicrania - a case report (abstract). Cephalalgia 2001; 21:506.
28. Rollnik JD, Karst M, Fink K, Dengler R. Botulinum toxin type and EMG: a key to the understand of chronic tension-type headaches? Headache 2001; 41: 985-9.
29. Zwart JA, Bovim G, Sand T, Sjaastad O. Tension headache: botulinum toxin paralysis of temporal muscles. Headache 1994; 34: 458-62.
30. Welch MJ, Punkiss JR, Foster KA. Sensitivity of embryonic rat dorsal root ganglia neurons to clostridium neurotoxins. Toxincon 2000; 38:245-58.
31. Yamâmura H, Malick A, Chamberlin NL, Burnstein R. Cardiovascular and neuronal responses to head stimulation reflect central sensitization and cutaneous allodynia in a rat model of migraine. J Neurophysiol 1999; 81: 479-93.
32. Fusco BM, Colantoni O, Giavovazzo M. Alteration of central excitation circuits in chronic headache and analgesic misuse. Headache 1997; 37: 486-91.
33. Pearce JM. Cervicogenic headache: a personal view. Cephalalgia 1995; 15: 463-9.
34. Pöllmann W, Keidel M, Pfaffenrath V. Headache and the cervical spine: a critical review. Cephalalgia 1997; 17: 801-16.
35. Simons D. Muscular pain syndromes. In: Friction JR. (ed). Advances in pain research and therapy, New York, Raven Press, 1990: 1.
36. Hartrick C. Pain due to trauma including sports injuries. In: Raj PP (ed). Practical Management of Pain, 2 ed, St Louis, Mosby Year Book 1992: 23.
37. Han SC. Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth 1997; 22: 89.
38. Simpson IX. Origin, structure, and pharmacological activity of botulinum toxin. Pharmacol Rev 1981; 33: 155.
39. Acquadro MA, Borodic GE. Treatment of myofascial pain with botulinum A toxin (letter). Anesthesiology 1994; 59: 65.
40. Cheshire WP, Abashian SW, Mann JD. Botulinum toxin in the treatment of myofascial pain syndrome. Pain 1994; 59 : 65-9.
41. IndahlA. Botulinum toxin type A in the treatment of patients after back surgery. BTX-A presentations at the 2nd World Congress of the World Institute of Pain. Istanbul, Turkey, 27-30 June 2001: 11-2.
42. Aşık İ, Yörükoğlu D, Ateş Y, Dilek U, Tüzüner F. Lumbal cerrahi sonrası kronik ağrı sendromunda botulinum toksini kullanımı. Türk Anesteziyoloji ve Reanimasyon Cemiyeti Mecmuası Özet Kitap, 2002:120.
43. Indahl A, Kaigle A, Reikeras O, Holm S. Electromyographic response of the porcine multifidus musculature after nerve stimulation. Spine. 1995 Dec 15;20(24):2652-8.
44. Indahl A, Kaigle AM, Reikeras O, Holm SH. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine 1997; 22(24):2834-40.