肌肉内毒素治疗复杂区域性疼痛综合征:对已发表病例的叙述性审查
Marc Klee1, Nilkolaj la Cour Karottki1, Bo Biering-Sørensen1,2
1Movement Disorder and Pain Research Center, Rigshospitalet Glostrup, 2600 Glostrup, Denmark.
Toxins
|July 25, 2025
概括
肌肉内注射的肉毒毒素 (BoNT) 在复杂区域性疼痛综合征 (CRPS) 中具有多种用途. 有限的证据存在,需要进行标准化研究来确定CRPS患者的疗效和安全性.
科学领域:
- 神经学 神经学
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 自20世纪80年代以来,肌肉内毒素 (BoNT) 已被用于复杂区域疼痛综合征 (CRPS).
- 现有的文献显示BoNT在CRPS的应用中存在显著的差异,包括理由,剂量和结果措施.
- 本综述综合了对CRPS的BoNT的证据,包括使用较旧术语的研究,如反射交感性缩症 (RSD).
研究的目的:
- 总结关于肌肉内注射肉毒毒素 (BoNT) 在被诊断为复杂区域疼痛综合征 (CRPS) 的患者中使用的已发表证据.
- 绘制CRPS中BoNT应用的现有景观,因为当前文献的异质和事性质.
主要方法:
- 通过PubMed和EMBASE数据库在2024年8月识别的研究的叙述性综述.
- 搜索术语包括"复杂区域疼痛综合征" (CRPS) 和"肉毒毒素".
- 在抽象和全文选后,包括25个出版物.
主要成果:
- 该审查包括来自单个病例报告,病例系列和小队列的数据,涉及至少96名接受肌内BoNT治疗的CRPS患者.
- 报告的结果非常异质.
- 关键的治疗参数,如毒素类型,目标肌肉,指导技术和剂量在研究中记录不一致.
结论:
- 目前关于CRPS肌肉内BoNT的证据有限且异质,排除了关于有效性或安全性的最终结论.
- 对于精选的CRPS病例来说,考虑BoNT可能是适当的,特别是那些有焦点 dystonia或肌肌关节疼痛的人.
- 标准化前性研究对于确定肌内BoNT在治疗CRPS中的临床作用至关重要.
相关概念视频
Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin
762
Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...
The binding of dantrolene to the RYR1...
762
Skeletal Muscle Relaxants: Therapeutic Uses
618
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
618
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
584
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
584
Peripherally and Centrally Acting Muscle Relaxants: A Comparison
3.7K
Skeletal muscle relaxants can target the central nervous system [CNS] to reduce muscle tension or act directly at the neuromuscular junction to induce temporary paralysis. These two classes of muscle relaxants are called centrally acting muscle relaxants and peripherally acting muscle relaxants. They differ in their action, mechanism, administration route, and clinical uses.
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic...
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic...
3.7K
Classification of Skeletal Muscle Relaxants
2.7K
Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
2.7K
Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action
2.1K
Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
2.1K


