Context

Botulinum Toxin type A (BTX-A) has historically been used as a treatment to reduce spasticity. However, its potential to treat neuropathic pain is increasingly being recognized in the literature. This clinical review examines the evidence regarding the use of BTX-A in directly treating neuropathic pain in the spinal cord injured population.

Methods

An electronic literature search was conducted in MEDLINE, PubMed and Scopus from inception to May 2020. The key words ‘spinal cord injury’ AND ‘neuropathic pain’ AND ‘botulinum toxin’ AND ‘human’ were used. The literature search produced a total of 65 results of which 14 duplicates were removed. There was 1 additional paper included following a manual search, providing a total of 52 papers. Taking into account inclusion and exclusion criteria, 2 case reports and 2 randomized control trials were reviewed.

Results

While there are multiple studies published on the use of BTX-A to manage neuropathic pain in other patient populations, there is very little published on its potential to treat spinal cord injury-related neuropathic pain. The provisional data provides some evidence that subcutaneous injection of BTX-A may benefit this patient group, although dosing and application schedules remain untested, and information on longer-term complications has yet to be been collected.

Conclusion

While early results are interesting, the quality and quantity of research published is not yet high enough to provide formal guidance on the use of BTX-A in treating central neuropathic pain in the spinal cord injury population. Further high-quality research is therefore recommended going forward.

中文翻译：

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使用 A 型肉毒杆菌毒素治疗脊髓损伤患者中枢神经性疼痛的临床评价

语境

A 型肉毒杆菌毒素 (BTX-A) 历来被用作减少痉挛的治疗方法。然而，其治疗神经性疼痛的潜力在文献中越来越受到认可。本临床综述检查了有关使用 BTX-A 直接治疗脊髓损伤人群神经性疼痛的证据。

方法

从开始到 2020 年 5 月，在 MEDLINE、PubMed 和 Scopus 中进行了电子文献检索。使用了关键词“脊髓损伤”和“神经性疼痛”和“肉毒杆菌毒素”和“人类”。文献检索共产生 65 个结果，其中删除了 14 个重复项。人工检索后又收录了 1 篇论文，共提供 52 篇论文。考虑到纳入和排除标准，审查了 2 个病例报告和 2 个随机对照试验。

结果

虽然已经发表了多项关于使用 BTX-A 治疗其他患者群体的神经性疼痛的研究，但关于其治疗脊髓损伤相关神经性疼痛的潜力的研究却很少。临时数据提供了一些证据表明皮下注射 BTX-A 可能有益于该患者群体，但剂量和应用时间表仍未经过测试，并且尚未收集有关长期并发症的信息。

结论

虽然早期结果很有趣，但已发表研究的质量和数量还不足以为使用 BTX-A 治疗脊髓损伤人群的中枢神经性疼痛提供正式指导。因此，建议继续进行进一步的高质量研究。