摘要:

Background:Myofascial pain syndrome (MPS) is defined as acute or chronic pain with sensory or motor autonomic symptoms, referred from active myofascial triggering points with associated dysfunction. Previous studies have suggested the usefulness of botulinum toxin A (BTX‐A) in the treatment of MPS since it is capable of controlling muscular spasms, as well as other alternative mechanisms of action.Objectives:To analyze the efficacy of BTX‐A treatment and its effect on daily life activities assessing pain reduction using a visual analogue scale (VAS); degree of improvement in physical impairment and disability scoring in the Oswestry low back pain questionnaire; and psychologic status using the Hospital Anxiety and Depression Scale (HAD), in patients suffering from MPS.Method:An open‐label interventional prospective trial was conducted in 77 patients diagnosed of refractory MPS (defined as the presence of muscle spasm with pain on mobilization or stretching, plus the existence of trigger points with associated referred pain), resistant to both conservative management and to physical therapy. The BTX‐A dosages for the different muscles were chosen according to a standardized protocol. Electromyographic guidance was used to localize the motor end plate prior to injection in superficial muscles; while fluoroscopic guidance was employed to evidence intramyofascial spread of the contrast solution within deep muscles. The assessment of treatment efficacy was based on a pain VAS applied before enrollment, at 15, 30, and 90 days and upon completion of the study; the Lattinen test to establish a relationship between pain intensity and its corresponding impact on daily living; and the HAD scale to assess psychologic stress, performed both before treatment and at the end of the study; and the Oswestry Questionnaire was used to evaluate patients' ability to carry out daily life activities according to their degree of physical impairment and disability scores.Results:The global analysis revealed a positive correlation between the VAS score prior to treatment and the scoring at 15, 30, and 90 days. This correlation was maintained when analyzing independently for superficial or deep muscles. The correlation coefficients for HAD scores and the Lattinen test values showed a significant association between pre‐ and post‐treatment findings. No adverse events were recorded for 83.1% of the cases.Conclusions:The results of this study are consistent with other studies showing the efficacy of BTX‐A for treating pain in MPS. The evaluation of the psychologic dimension of this disorder and its associated disability can provide valuable information for the adequate management of these patients and for assessing treatment outcome.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:The role of serotonin in the modulation of nociceptive input has been widely studied, and a link between serum serotonin (S‐5HT) and pain thresholds elicited in patients with chronic painful pathologies has been shown. In the light of contradictory concepts on pain message modulation by S‐5HT, this study tries to define whether S‐5HT displays a nociceptive or antinociceptive role in experimental pain evaluation in healthy volunteers.Design:In 20 healthy young volunteers, 10 men and 10 women (21 ± 2 years old), blood serotonin measurements were made, pressure pain thresholds was determined, and statistical analysis was performed.Results:This study showed a significant negative correlation of total blood serotonin with experimental pain detection threshold (P< 0.05,r= 0.444), but not with pain tolerance, while sex‐related correlations of serotonin and thresholds were not significant. Lower serotonin concentration (P= 0.02), higher pain threshold (P< 0.01), and higher pain tolerance (P= 0.02) in men than in women were observed.Conclusion:Low pain detection thresholds may be explained by a peripheral nociceptive effect of serotonin. Pain tolerance does not, however, encompass a similar pattern of serotoninergic involvement in pain control and may include other components that remain to be elucidated. These results call for further studies on a larger population.

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:2003

数据来源: OVID