Toxina botulínica no tratamento da dor

Orlando Carlos Gomes Colhado; Marcelo Boeing; Luciano Bornia Ortega

doi:10.1590/S0034-70942009000300013

Review Article

Toxina botulínica no tratamento da dor

Botulinum toxin in pain treatment

Orlando Carlos Gomes Colhado; Marcelo Boeing; Luciano Bornia Ortega

http://dx.doi.org/10.1590/S0034-70942009000300013 Braz J Anesthesiol, vol.59, n3, p.366-381, 2009

PDF

Downloads: 10

Resumo

JUSTIFICATIVA E OBJETIVOS: A toxina botulínica (TxB), uma das mais potentes toxinas bacterianas conhecidas, tem reconhecidamente ação terapêutica eficaz no tratamento de algumas síndromes dolorosas. Entretanto, algumas de suas indicações ainda estão em fase de comprovação com relação a sua eficácia. O objetivo deste estudo foi revisar o histórico, propriedades farmacológicas e aplicações clinicas da TxB, quando empregada no tratamento de dores de diferentes origens. CONTEÚDO: A TxB é o produto da fermentação do Clostridium Botulinum, uma bactéria anaeróbia Gram-positiva. Comercialmente, as TxB existem nas formas A e B, agentes biológicos obtidos laboratorialmente. A TxB, uma neurotoxina que possui alta afinidade pelas sinapses colinérgicas, ocasiona bloqueio na liberação de acetilcolina pelo terminal nervoso, sem alterar a condução neural de sinais elétricos ou síntese e armazenamento de acetilcolina. Comprovadamente, a TxB pode enfraquecer seletivamente a musculatura dolorosa, interrompendo o ciclo espasmo-dor. Com relação à dor, varias publicações têm demonstrado a eficácia e segurança da TxB-A no tratamento da cefaleia tipo tensão, migrânea, dor lombar crônica e dor miofascial. CONCLUSÕES: A TxB-A é segura e bem tolerada em desordens dolorosas crônicas, onde regimes de farmacoterapia podem sabidamente provocar efeitos colaterais. Outra vantagem é a redução do uso de analgésicos e o tempo de ação de 3 a 4 meses por dose. Entretanto pesquisas futuras serão necessárias para se estabelecer a eficácia da TxB-A em desordens dolorosas crônicas e seu exato mecanismo no alivio da dor, bem como seu potencial em tratamentos multifatoriais.

Palavras-chave

DOR, Crônica, DROGAS

Abstract

BACKGROOUND AND OBJECTIVES: Botulinum toxin (BTX) is one of the most potent bacterial toxins known and its effectiveness in the treatment of some pain syndromes is well known. However, the efficacy of some of its indications is still in the process of being confirmed. The objective of this study was to review the history, pharmacological properties, and clinical applications of BTX in the treatment of pain of different origins. CONTENTS: Botulinum toxin is produced by fermentation of Clostridium botulinum, a Gram-positive, anaerobic bacterium. Commercially, BTX comes in two presentations, types A and B. Botulinum toxin, a neurotoxin with high affinity for cholinergic synapses, blocks the release of acetylcholine by nerve endings without interfering with neuronal conduction of electrical signals or synthesis and storage of acetylcholine. It has been proven that BTX can selectively weaken painful muscles, interrupting the spasm-pain cycle. Several studies have demonstrated the efficacy and safety of BTX-A in the treatment of tension headaches, migraines, chronic lumbar pain, and myofascial pain. CONCLUSIONS: Botulinum toxin type A is well tolerated in the treatment of chronic pain disorders in which pharmacotherapy regimens can cause side effects. The reduction in the consumption of analgesics and length of action of 3 to 4 months per dose represent other advantages of its use. However, further studies are necessary to establish the efficacy of BTX-A in chronic pain disorders and its exact mechanism of action, as well as its potential in multifactorial treatments.

Keywords

DRUGS, PAIN, chronic

References

Dressler D, Saberi FA, Barbosa ER. Botulinum toxin: mechanisms of action. Arq Neuropsiquiatr. 2005;63:180-185.

Lang A. History and uses of BOTOX (botulinum toxin type A). Lippincott's Case Manag. 2004;9:109-112.

Wenzel RG. Pharmacology of botulinum neurotoxin serotype A. Am J Heath-Syst Pharm. 2004;61(^s6):s5-10.

Setler PE. Therapeutic use of botulinum toxins: background and history. Clin J Pain. 2002;18(^s6):s119-124.

Aguilar-Rebolledo F, Hernandez-Sanchez J, Rayo-Mares D. Toxina botulínica como tratamiento de la espasticidad y distonia en la parálisis cerebral infantil. Gac Méd Mex. 2001;137:403-411.

Wohlfarth K, Kampe K, Bigalke H. Pharmacokinetic properties of different formulations of botulinum neurotoxin type A. Mov Disord. 2004;19:s65-67.

Unno Ek, Sakato RK, Issy AM. Estudo comparativo entre toxina botulínica e bupivacaína para infiltração de pontos-gatilho em síndrome dolorosa miofascial crônica. Rev Bras Anestesiol. 2005;55:250-255.

Purves D, Augustine GJ, Fitzpatrick D. Neuroscience. 2004:110-116.

Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology. 2005;26:785-793.

Freund B, Schwartz M. Temporal relationship of muscle weakness and pain reduction in subjects treated with botulinum toxin A. J Pain. 2003;4:159-165.

Aoki KR. Pharmacology and immunology of botulinum toxin serotypes. J Neurol. 2001;248(^s1):3-10.

Dressler D, Chaná Cuevas P. La toxina botulínica tipo B: Dónde estamos?. Rev Chil Neuro-psiquiatr. 2002;40:6-8.

Mejia NI, Vuong KD, Jankovic J. Long-term botulinum toxin efficacy, safety and immunogenicity. Mov Disord. 2005;20:592-597.

Cardoso F. Toxina botulínica tipo B no manejo de distonia não-responsiva à toxina botulínica tipo A. Arq Neuropsiquiatr. 2003;61:607-610.

Yablon S. Toxin neutralizing antibody formation with botulinum toxin type A (BoNTA) treatment in neuromuscular disorders. Neurology. 2005;64:1153.

Comella CL. Interim results of an observation study of neutralizing antibody formation with the current preparation of botulinum toxin type A treatment for cervical dystonia. Neurology. 2004;62:6141.

Graboski CL, Gray DS, Burnham RS. Botulinum toxin A versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: A randomised double blind crossover study. Pain. 2005;118:170-175.

Sycha T, Samal D, Chizh B. A lack of antinociceptive or antiinflammatory effect of botulinum toxin A in an inflammatory human pain model. Anesth Analg. 2006;102:509-516.

Sheeran G. Botulinum toxin for the treatment of musculoskeletal pain and spasm. Curr Pain Headache Rep. 2002;6:460-469.

Göbel H, Heinze A, Heinze-Kuhn K. Botulinun toxin A in the treatment of headache syndromes and pericranial pain syndromes. Pain. 2001;91:195-199.

Lew MF. Review of the FDA-approved uses of botulinum toxins, including data suggesting efficacy in pain reduction. Clin J Pain. 2002;18(^s6):s142-146.

Porta M. A comparative trial of botulinum toxin type A and methilprednisolone for the treatment of myofascial pain syndrome and pain for chronic muscle spasm. Pain. 2000;85:101-105.

Klein AW. The therapeutic potential of botulinum toxin. Dermatol Surg. 2004;30:452-455.

Porta M, Perreti A, Gamba M. The rationale and results of treating muscle spasm and myofascial syndromes with botulinum toxin type A. Pain Digest. 1998;8:346-352.

Kamanli A, Kaya A, Ardicoglu O. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int. 2005;25:604-611.

von Lindern JJ, Niederhagen B, Bergé S. Type A botulinum toxin in the treatment of chronic facial pain associated with masticatory hyperactivity. J Oral Maxillofac Surg. 2003;61:774-778.

Jabbari B, Ney J, Sichani A. Treatment of refractory, chronic low back pain with botulinum neurotoxin A: an open-label, pilot study. Pain Med. 2006;7:260-264.

Gassner HG, Sherris DA. Addition of an anesthetic agent to enhance the predictability of the effects of botulinum toxin type A injections: a randomized controlled study. Mayo Clin Proc. 2000;75:701-704.

Silberstein SD, Gobel H, Jensen R. Botulinum toxin type A in the prophylactic treatment of chronic tension-type headache: a multicentre, double-blind, randomized, placebo-controlled, parallel-group study. Cephalalgia. 2006;26:790-800.

Smuts JA, Schultz D, Barnard A. Mechanism of action of botulinum toxin type A in migraine prevention: a pilot study. Headache. 2004;44:801-805.

Allen G, Galer BS, Schwartz L. Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients. Pain. 1999;80:539-544.

Argoff CE. Botulinum toxin type A treatment of myofascial pain with CRPS type I (reflex sympathetic dystrophy): a pilot study. . .

Jabbari B, Maher N. Effectiveness of botulinum toxin A against the segmental burning pain of spinal cord origin. . .

Lang AM. Botulinum toxin type A therapy in chronic pain disorders. Arch Phys Med Rehabil. 2003;84(3^s1):s69-73.

Toxina botulínica no tratamento da dor

Botulinum toxin in pain treatment

Orlando Carlos Gomes Colhado; Marcelo Boeing; Luciano Bornia Ortega

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol