By W. H. Jost
The highly winning historical past of botulinum toxin and its most likely destiny has rarely an identical. at the beginning, it used to be utilized in strabismus, blepharospasm and hemifacial spasm, later additionally in focal dystonia and spasticity and it's been proven to successfully deal with wrinkles, hyperhidrosis and lots of resulting symptoms. via treating indicators or issues linked to ache, its analgesic influence was once first spotted. The efficacy and purposes for this facet impact have when you consider that been investigated and a couple of types explaining the mode of motion were provided. although, whether we all know that botulinum toxin surely is helping in yes discomfort syndromes, there's nonetheless a lot paintings to do to spot the main ones, outline the optimal dose and the popular website of injection. Indicating present positions and kindling the turning out to be curiosity during this striking healing agent this publication provides a well timed evaluation on ache administration with botulinum toxin.
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Extra resources for Botulinum Toxin in Painful Diseases (Pain and Headache)
21]. While significant relief of motor symptoms was seen in about 69% of patients with focal dystonia, 74% of them experienced pain relief . Since now (July 2002) the research on the potentials on BTX in pain conditions has been extended and nearly 300 publications are listed in a PubMed search containing the words ‘botulinum’ and ‘pain’. The first publications concerning the effects of BTX in myofascial pain were released by Acquadro and Borodic  as a case report in 1994 and by Cheshire et al.
Pain 1994;59:65–69. Alo KM, Yland MJ, Kramer DL, Charnov JH, Redko V: Botulinum toxin in the treatment of myofascial pain. Pain Clin 1997;10:107–116. Wheeler AH, Goolkasian P, Gretz SS: A randomized, double-blind, prospective pilot study of botulinum toxin injection for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome. Spine 1998;23:1662–1666. Freund BJ, Schwartz M: Treatment of whiplash associated neck pain with botulinum toxin-A: A pilot study. J Rheumatol 2000;27:481–484.
1). The hypothesized primary dysfunction is an abnormal increase in release of acetylcholine from the motor endplate due to a muscular overload. This leads to a sustained depolarization of the post-junctional membrane of the muscle fiber and could cause a continuous release and inadequate uptake of calcium ions from local sarcoplasmatic reticulum with a sustained contraction of sarcomeres. While all these changes would increase energy demand, the Reilich/Pongratz 24 Table 1. 5–3:1 female Onset Exaggeration of central summation of nociceptive input from muscles Muscular overload Diagnostic criteria Established (American College of Rheumatology, 1990) Not established, only typical clinical characteristics Clinical findings Tenderness of tendon insertions (‘tender points’) by palpation or algometry in at least 11 of 18 points Local or regional tender spots within a palpable taut band of muscle fibers with twitch response to stimulation and referred pain pattern Inter-rater reliability Good for palpation or algometry Good for all features with experienced and trained examiners Pain Diffuse, no relation to tender points Localized, in relation to trigger points Pain referral Rarely Localized Sleep disorder About 40% of patients Often Fatigue Common Rarely Irritable bowel symptoms Common Uncommon Treatment Medications, manual therapies Local myofascial release by manual therapies and needling techniques Local injections Uncertain Good results in case series Outcome Usually chronic Frequently chronification in presence of perpetuating factors Comment 72% also have active trigger points 20% also have fibromyalgia continuous muscle fiber contraction compresses local blood vessels reducing further nutrient and oxygen supply.