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Moreau N, Korai SA, Sepe G, Panetsos F, Papa M, Cirillo G. Peripheral and central neurobiological effects of botulinum toxin A (BoNT/A) in neuropathic pain: a systematic review. Pain 2024; 165:1674-1688. [PMID: 38452215 DOI: 10.1097/j.pain.0000000000003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/07/2023] [Indexed: 03/09/2024]
Abstract
ABSTRACT Botulinum toxin (BoNT), a presynaptic inhibitor of acetylcholine (Ach) release at the neuromuscular junction (NMJ), is a successful and safe drug for the treatment of several neurological disorders. However, a wide and recent literature review has demonstrated that BoNT exerts its effects not only at the "periphery" but also within the central nervous system (CNS). Studies from animal models, in fact, have shown a retrograde transport to the CNS, thus modulating synaptic function. The increasing number of articles reporting efficacy of BoNT on chronic neuropathic pain (CNP), a complex disease of the CNS, demonstrates that the central mechanisms of BoNT are far from being completely elucidated. In this new light, BoNT might interfere with the activity of spinal, brain stem, and cortical circuitry, modulating excitability and the functional organization of CNS in healthy conditions. Botulinum toxins efficacy on CNP is the result of a wide and complex action on many and diverse mechanisms at the basis of the maladaptive plasticity, the core of the pathogenesis of CNP. This systematic review aims to discuss in detail the BoNT's mechanisms and effects on peripheral and central neuroplasticity, at the basis for the clinical efficacy in CNP syndromes.
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Affiliation(s)
- Nathan Moreau
- Laboratoire de Neurobiologie oro-faciale, EA 7543, Université Paris Cité, Paris, France
| | - Sohaib Ali Korai
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanna Sepe
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fivos Panetsos
- Neurocomputing & Neurorobotics Research Group, Universidad Complutense de Madrid, Instituto de Investigaciones Sanitarias (IdISSC), Hospital Clinico San Carlos de Madrid, Silk Biomed SL, Madrid, Spain
| | - Michele Papa
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Cirillo
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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2
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Spagna A, Attal N. Pharmacotherapy and noninvasive neurostimulation for neuropathic pain. Presse Med 2024; 53:104233. [PMID: 38636787 DOI: 10.1016/j.lpm.2024.104233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
Neuropathic pain poses a significant challenge due to its complex mechanisms, necessitating specific treatments. In recent decades, significant progress has been made in the clinical research of neuropathic pain, marking a shift from empirical strategies to evidence-based medicine in its management. This review outlines both pharmacological and non-pharmacological interventions. Antidepressants (tricyclic and serotonin-noradrenaline reuptake inhibitors), antiepileptics (gabapentin, pregabalin), and topical agents constitute the main pharmacological treatments. These approaches target peripheral or central mechanisms associated with neuropathic pain. Noninvasive neurostimulation, including transcutaneous electrical nerve stimulation (TENS) and repetitive transcranial magnetic stimulation (rTMS), provides non-pharmacological alternatives. However, challenges persist in effectively targeting existing medications and developing drugs that act on novel targets, necessitating innovative therapeutic strategies.
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Affiliation(s)
- Annachiara Spagna
- CETD, Ambroise Pare Hospital, APHP, 92100 Boulogne-Billancourt, France
| | - Nadine Attal
- CETD, Ambroise Pare Hospital, APHP, 92100 Boulogne-Billancourt, France; Inserm U987, UVSQ-Paris-Saclay University, Ambroise Pare Hospital, APHP, 92100 Boulogne-Billancourt, France.
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3
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Coraci D, Maccarone MC, Ragazzo L, Tognolo L, Restivo DA, Santilli G, Moreira AL, Ferrara PE, Ronconi G, Masiero S. Botulinum toxin in the rehabilitation of painful syndromes: multiperspective literature analysis, lexical analysis and systematic review of randomized controlled trials. Eur J Transl Myol 2024; 34. [PMID: 38767308 DOI: 10.4081/ejtm.2024.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/22/2024] Open
Abstract
Pain represents a common symptom of several diseases and is often associated with a reduction in rehabilitation outcomes and recovery. The effectiveness of pain alleviation by botulinum toxin has been recently demonstrated. We searched in PubMed the papers about this topic published in the last ten years, and we selected clinical trials, guidelines, meta-analyses, reviews, and systematic reviews. We used different approaches: multiperspective presentation, lexical evaluation, and systematic review. The systematic review was only performed for the randomized controlled trials. We predominantly found reviews and trials about the rehabilitation of stroke/brain injury and epicondylitis. The most common outcome measures were pain, function, and spasticity. Among the common words, pain was the most frequent and the terms were grouped into different families, especially concerning the outcomes. Rehabilitation showed a relatively low frequency. Finally, the systematic review showed moderate-low levels of bias which confirms the effectiveness of botulinum toxin for pain treatment. The current literature about botulinum toxin is wide and globally diffuse but with some limitations in study strategies and clearness in the formal presentation. The evidence justifies the use of botulinum toxin in treating pain in different diseases.
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Affiliation(s)
- Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | | | - Lisa Ragazzo
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | - Lucrezia Tognolo
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | | | - Gabriele Santilli
- Department of Anatomical, Histological and Legal Medical Sciences and Science of the Locomotor System, Rome.
| | - Ana Lucila Moreira
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo.
| | | | | | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
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Shetty A, Delanerolle G, Cavalini H, Deng C, Yang X, Boyd A, Fernandez T, Phiri P, Bhaskar A, Shi JQ. A systematic review and network meta-analysis of pharmaceutical interventions used to manage chronic pain. Sci Rep 2024; 14:1621. [PMID: 38238384 PMCID: PMC10796361 DOI: 10.1038/s41598-023-49761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
It is estimated 1.5 billion of the global population suffer from chronic pain with prevalence increasing with demographics including age. It is suggested long-term exposure to chronic could cause further health challenges reducing people's quality of life. Therefore, it is imperative to use effective treatment options. We explored the current pharmaceutical treatments available for chronic pain management to better understand drug efficacy and pain reduction. A systematic methodology was developed and published in PROSPERO (CRD42021235384). Keywords of opioids, acute pain, pain management, chronic pain, opiods, NSAIDs, and analgesics were used across PubMed, Science direct, ProQuest, Web of science, Ovid Psych INFO, PROSPERO, EBSCOhost, MEDLINE, ClinicalTrials.gov and EMBASE. All randomised controlled clinical trials (RCTs), epidemiology and mixed-methods studies published in English between the 1st of January 1990 and 30th of April 2022 were included. A total of 119 studies were included. The data was synthesised using a tri-partied statistical methodology of a meta-analysis (24), pairwise meta-analysis (24) and network meta-analysis (34). Mean, median, standard deviation and confidence intervals for various pain assessments were used as the main outcomes for pre-treatment pain scores at baseline, post-treatment pain scores and pain score changes of each group. Our meta-analysis revealed the significant reduction in chronic pain scores of patients taking NSAID versus non-steroidal opioid drugs was comparative to patients given placebo under a random effects model. Pooled evidence also indicated significant drug efficiency with Botulinum Toxin Type-A (BTX-A) and Ketamine. Chronic pain is a public health problem that requires far more effective pharmaceutical interventions with minimal better side-effect profiles which will aid to develop better clinical guidelines. The importance of understanding ubiquity of pain by clinicians, policy makers, researchers and academic scholars is vital to prevent social determinant which aggravates issue.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, UK.
- University College London, 235, Euston Road, London, NW1 2BU, UK.
- Pain Medicine, Cleveland Clinic London, London, United Kingdom.
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX3 7JX, UK
| | - Heitor Cavalini
- Southern Health NHS Foundation Trust, Southampton, SO40 2RZ, UK
| | - Chunli Deng
- Southern University of Science and Technology, Shenzhen, 518055, China
| | - Xiaojie Yang
- School of Statistics and Mathematics, Yunnan University of Finance and Economics, Kunming, China
- National Centre for Applied Mathematics Shenzhen, Shenzhen, China
| | - Amy Boyd
- University of Oxford, Oxford, UK
| | - Tacson Fernandez
- University College London, 235, Euston Road, London, NW1 2BU, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, SO40 2RZ, UK
- Psychology Department, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Arun Bhaskar
- Imperial College Healthcare NHS Trust, London, UK
| | - Jian Qing Shi
- Southern Health NHS Foundation Trust, Southampton, SO40 2RZ, UK
- Southern University of Science and Technology, Shenzhen, 518055, China
- School of Statistics and Mathematics, Yunnan University of Finance and Economics, Kunming, China
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Intiso D, Centra AM, Gravina M, Chiaramonte A, Bartolo M, Di Rienzo F. Botulinum Toxin-A High-Dosage Effect on Functional Outcome and Spasticity-Related Pain in Subjects with Stroke. Toxins (Basel) 2023; 15:509. [PMID: 37624266 PMCID: PMC10467116 DOI: 10.3390/toxins15080509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Stroke patients can develop spasticity and spasticity-related pain (SRP). These disorders are frequent and can contribute to functional limitations and disabling conditions. Many reports have suggested that higher doses than initially recommended of BTX-A can be used effectively and safely, especially in the case of severe spasticity; however, whether the treatment produces any benefit on the functional outcome and SRP is unclear. Studies published between January 1989 and December 2022 were retrieved from MEDLINE/PubMed, Embase, and Cochrane Central Register. Only obabotulinumtoxinA (obaBTX-A), onabotulinumtoxinA, (onaBTX-A), and incobotulinumtoxinA (incoBTX-A) were considered. The term "high dosage" indicates ≥600 U. Nine studies met the inclusion criteria. Globally, 460 subjects were treated with BTX-A high dose, and 301 suffered from stroke. Studies had variable method designs, sample sizes, and aims. Only five (55.5%) reported data about the functional outcome after BTX-A injection. Functional measures were also variable, and the improvement was observed predominantly in the disability assessment scale (DAS). SRP pain was quantified by visual analog scale (VAS) and only three studies reported the BTX-A effect. There is no scientific evidence that this therapeutic strategy unequivocally improves the functionality of the limbs. Although no clear-cut evidence emerges, certain patients with spasticity might obtain goal-oriented improvement from high-dose BTX-A. Likewise, data are insufficient to recommend high BTX dosage in SRP.
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Affiliation(s)
- Domenico Intiso
- Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS ‘Casa Sollievo della Sofferenza’, Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (A.M.C.); (M.G.); (A.C.); (F.D.R.)
| | - Antonello Marco Centra
- Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS ‘Casa Sollievo della Sofferenza’, Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (A.M.C.); (M.G.); (A.C.); (F.D.R.)
| | - Michele Gravina
- Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS ‘Casa Sollievo della Sofferenza’, Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (A.M.C.); (M.G.); (A.C.); (F.D.R.)
| | - Angelo Chiaramonte
- Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS ‘Casa Sollievo della Sofferenza’, Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (A.M.C.); (M.G.); (A.C.); (F.D.R.)
| | - Michelangelo Bartolo
- Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Zingonia, Ciserano, 24040 Bergamo, Italy;
| | - Filomena Di Rienzo
- Unit of Neuro-Rehabilitation Unit and Rehabilitation Medicine, IRCCS ‘Casa Sollievo della Sofferenza’, Viale dei Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (A.M.C.); (M.G.); (A.C.); (F.D.R.)
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6
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Attal N, Bouhassira D, Colvin L. Advances and challenges in neuropathic pain: a narrative review and future directions. Br J Anaesth 2023; 131:79-92. [PMID: 37210279 DOI: 10.1016/j.bja.2023.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/20/2023] [Accepted: 04/05/2023] [Indexed: 05/22/2023] Open
Abstract
Over the past few decades, substantial advances have been made in neuropathic pain clinical research. An updated definition and classification have been agreed. Validated questionnaires have improved the detection and assessment of acute and chronic neuropathic pain; and newer neuropathic pain syndromes associated with COVID-19 have been described. The management of neuropathic pain has moved from empirical to evidence-based medicine. However, appropriately targeting current medications and the successful clinical development of drugs acting on new targets remain challenging. Innovative approaches to improving therapeutic strategies are required. These mainly encompass rational combination therapy, drug repurposing, non-pharmacological approaches (such as neurostimulation techniques), and personalised therapeutic management. This narrative review reports historical and current perspectives regarding the definitions, classification, assessment, and management of neuropathic pain and explores potential avenues for future research.
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Affiliation(s)
- Nadine Attal
- Inserm U987, UVSQ-Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France.
| | - Didier Bouhassira
- Inserm U987, UVSQ-Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Lesley Colvin
- University of Dundee, Ninewells Medical School, Ninewells Hospital, Dundee, UK
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7
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Spagna A, Attal N. Botulinum toxin A and neuropathic pain: An update. Toxicon 2023:107208. [PMID: 37385479 DOI: 10.1016/j.toxicon.2023.107208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
Botulinum toxin type A is a widely used neurotoxin for the treatment of muscle hyperactivity such as dystonia and spasticity. Several clinical trials have also reported an efficacy of subcutaneous or intradermal administrations of botulinum toxin A on various neuropathic pain conditions including idiopathic trigeminal neuralgia and found that specific sensory phenotypes were predictors of the response. This narrative review summarizes the potential mechanisms of action, efficacy and safety of botulinum toxin A in neuropathic pain as well as its place in the therapeutic algorithm of neuropathic pain.
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Affiliation(s)
- A Spagna
- CETD, Ambroise Pare Hospital, APHP, 92100, Boulogne-Billancourt, France.
| | - N Attal
- CETD, Ambroise Pare Hospital, APHP, 92100, Boulogne-Billancourt, France; Inserm U987, UVSQ-Paris-Saclay University, Ambroise Pare Hospital, APHP, 92100, Boulogne-Billancourt, France.
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8
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Schwarzer A, Mäcken T, Enax-Krumova EK. [Clinical use of botulinum toxin type A in pain medicine]. Schmerz 2023:10.1007/s00482-023-00730-9. [PMID: 37365293 DOI: 10.1007/s00482-023-00730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 06/28/2023]
Abstract
Botulinum toxin has been used for decades in the treatment of a variety of painful diseases. Botulinum toxin not only blocks neuromuscular transmission, but also the secretion of neuropeptides, such as substance P, glutamate and calcitonin gene-related peptide (CGRP) and thus inhibits neurogenic inflammation. In addition, it has a modulatory pain-relieving effect via retrograde transport into the central nervous system. In addition to approval for the treatment of dystonia or spasticity, onabotulinum toxin A is also approved for the prophylaxis of chronic migraine if the oral prophylactic migraine medication has had an insufficient effect or has not been tolerated. In addition, botulinum toxin is also recommended in guidelines as a third-line treatment for neuropathic pain, but in Germany this is an off-label application. This article provides an overview of the current clinically relevant areas of application of botulinum toxin in the field of pain medicine.
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Affiliation(s)
- A Schwarzer
- Abteilung für Schmerzmedizin, BG Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, BG Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, Deutschland.
| | - T Mäcken
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, BG Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, Deutschland
| | - E K Enax-Krumova
- Neurologische Klinik, BG Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bochum, Deutschland
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9
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Ferraro MC, Cashin AG, Wand BM, Smart KM, Berryman C, Marston L, Moseley GL, McAuley JH, O'Connell NE. Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews. Cochrane Database Syst Rev 2023; 6:CD009416. [PMID: 37306570 PMCID: PMC10259367 DOI: 10.1002/14651858.cd009416.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a chronic pain condition that usually occurs in a limb following trauma or surgery. It is characterised by persisting pain that is disproportionate in magnitude or duration to the typical course of pain after similar injury. There is currently no consensus regarding the optimal management of CRPS, although a broad range of interventions have been described and are commonly used. This is the first update of the original Cochrane review published in Issue 4, 2013. OBJECTIVES To summarise the evidence from Cochrane and non-Cochrane systematic reviews of the efficacy, effectiveness, and safety of any intervention used to reduce pain, disability, or both, in adults with CRPS. METHODS We identified Cochrane reviews and non-Cochrane reviews through a systematic search of Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, CINAHL, PEDro, LILACS and Epistemonikos from inception to October 2022, with no language restrictions. We included systematic reviews of randomised controlled trials that included adults (≥18 years) diagnosed with CRPS, using any diagnostic criteria. Two overview authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools respectively. We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes quality of life, emotional well-being, and participants' ratings of satisfaction or improvement with treatment. MAIN RESULTS: We included six Cochrane and 13 non-Cochrane systematic reviews in the previous version of this overview and five Cochrane and 12 non-Cochrane reviews in the current version. Using the AMSTAR 2 tool, we judged Cochrane reviews to have higher methodological quality than non-Cochrane reviews. The studies in the included reviews were typically small and mostly at high risk of bias or of low methodological quality. We found no high-certainty evidence for any comparison. There was low-certainty evidence that bisphosphonates may reduce pain intensity post-intervention (standardised mean difference (SMD) -2.6, 95% confidence interval (CI) -1.8 to -3.4, P = 0.001; I2 = 81%; 4 trials, n = 181) and moderate-certainty evidence that they are probably associated with increased adverse events of any nature (risk ratio (RR) 2.10, 95% CI 1.27 to 3.47; number needed to treat for an additional harmful outcome (NNTH) 4.6, 95% CI 2.4 to 168.0; 4 trials, n = 181). There was moderate-certainty evidence that lidocaine local anaesthetic sympathetic blockade probably does not reduce pain intensity compared with placebo, and low-certainty evidence that it may not reduce pain intensity compared with ultrasound of the stellate ganglion. No effect size was reported for either comparison. There was low-certainty evidence that topical dimethyl sulfoxide may not reduce pain intensity compared with oral N-acetylcysteine, but no effect size was reported. There was low-certainty evidence that continuous bupivacaine brachial plexus block may reduce pain intensity compared with continuous bupivacaine stellate ganglion block, but no effect size was reported. For a wide range of other commonly used interventions, the certainty in the evidence was very low and provides insufficient evidence to either support or refute their use. Comparisons with low- and very low-certainty evidence should be treated with substantial caution. We did not identify any RCT evidence for routinely used pharmacological interventions for CRPS such as tricyclic antidepressants or opioids. AUTHORS' CONCLUSIONS Despite a considerable increase in included evidence compared with the previous version of this overview, we identified no high-certainty evidence for the effectiveness of any therapy for CRPS. Until larger, high-quality trials are undertaken, formulating an evidence-based approach to managing CRPS will remain difficult. Current non-Cochrane systematic reviews of interventions for CRPS are of low methodological quality and should not be relied upon to provide an accurate and comprehensive summary of the evidence.
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Affiliation(s)
- Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Benedict M Wand
- The School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Keith M Smart
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Carolyn Berryman
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- School of Biomedicine, The University of Adelaide, Kaurna Country, Adelaide, Australia
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
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10
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Peng F, Xia TB. Effects of Intradermal Botulinum Toxin Injections on Herpes Zoster Related Neuralgia. Infect Drug Resist 2023; 16:2159-2165. [PMID: 37077249 PMCID: PMC10106788 DOI: 10.2147/idr.s401972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
Background Postherpetic neuralgia (PHN), which represents the most common chronic complication of herpes zoster, is characterized by intense pain and is difficult to treat. In fact, no treatments are currently available that can effectively reduce the pain associated with PHN. Recent evidence has been presented indicating that Botulinum toxin (BoNT-A) can serve as an effective and safe treatment for peripheral neuropathic pain. Objective The effects of intradermal BoNT-A injections on herpes zoster related neuralgia were investigated in this study. Methods Patients diagnosed with herpes zoster related acute neuralgia (N=13 - acute group) and those diagnosed with postherpetic neuralgia (N=17 - PHN group) were enrolled in this study. The two groups were treated with intradermal injections of BoNT-A at the site of their affected pain areas and were then assessed at 1 day, 1 week, 2 weeks, 1 month, 2 months and 3 months after their BoNT-A treatments. Results When compared with pre-treatment values, Visual Analogue Scores (VAS) in all patients were all significantly decreased at all times tested following BoNT-A injection. Before treatment, PHN patients had significantly higher VAS than those in the acute group. However, after 1 day of treatment, there was no difference in VAS between the two groups. None of the patients in the acute phase treated with BoNT-A developed PHN. Conclusion BoNT-A injections significantly reduced herpetic-related pain and proved to be a more effective treatment for the PHN versus acute pain group. Moreover, an early application of BoNT-A can alleviate the probability of developing PHN.
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Affiliation(s)
- Fen Peng
- Department of Dermatology, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Tian-Bao Xia
- Department of Dermatology, People’s Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, People’s Republic of China
- Correspondence: Tian-Bao Xia, Department of Dermatology, People’s Liberation Army Strategic Support Force Characteristic Medical Center, No. 9th Anxiang Beili Road, Chaoyang District, Beijing, 100101, People’s Republic of China, Email
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11
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Hary V. Authors' reply on the comment by Slawek. Eur J Pain 2022; 26:2257-2258. [PMID: 36065990 DOI: 10.1002/ejp.2030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Vincent Hary
- Université de Paris, Paris, France.,Pain Unit, Hôpital Raymond Poincar, APHP, Garches, France
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12
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Weng HJ, Pham QTT, Chang CW, Tsai TF. Druggable Targets and Compounds with Both Antinociceptive and Antipruritic Effects. Pharmaceuticals (Basel) 2022; 15:ph15070892. [PMID: 35890193 PMCID: PMC9318852 DOI: 10.3390/ph15070892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022] Open
Abstract
Pain and itch are both important manifestations of various disorders, such as herpes zoster, atopic dermatitis, and psoriasis. Growing evidence suggests that both sensations have shared mediators, overlapping neural circuitry, and similarities in sensitization processes. In fact, pain and itch coexist in some disorders. Determining pharmaceutical agents and targets for treating pain and itch concurrently is of scientific and clinical relevance. Here we review the neurobiology of pain and itch and discuss the pharmaceutical targets as well as novel compounds effective for the concurrent treatment of these sensations.
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Affiliation(s)
- Hao-Jui Weng
- Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan;
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
| | - Quoc Thao Trang Pham
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
| | - Chia-Wei Chang
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei 100225, Taiwan
- Correspondence:
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Slawek J. "Botulinum toxin A brands are not the same medications. A comment on Hary et al.". Eur J Pain 2022; 26:1396. [PMID: 35511458 DOI: 10.1002/ejp.1969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jaroslaw Slawek
- Neurological-Psychiatric Nursing Department, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
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Lippi L, de Sire A, Folli A, D’Abrosca F, Grana E, Baricich A, Carda S, Invernizzi M. Multidimensional Effectiveness of Botulinum Toxin in Neuropathic Pain: A Systematic Review of Randomized Clinical Trials. Toxins (Basel) 2022; 14:toxins14050308. [PMID: 35622555 PMCID: PMC9145715 DOI: 10.3390/toxins14050308] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
Although botulinum toxin (BoNT) has been suggested as a treatment to counter neuropathic pain, no previous systematic reviews investigated the multidimensional effects of BoNT on pain relief and Health-Related Quality of Life (HR-QoL). The aim of this systematic review is to summarize the current evidence on the effectiveness of BoNT treatment for neuropathic pain, and to characterize its multidimensional effectiveness in order to guide physicians in clinical practice. Five databases were systematically searched up to 4 April 2022, to identify randomized controlled trials satisfying the following criteria: adults suffering from neuropathic pain, BoNT administration, any comparator, multidimensional assessment of pain as primary outcome, HR-QoL, physical function, anxiety and depression, and sleep quality as secondary outcomes. Twelve studies were included. The multidimensional pain scales used were short-form McGill Pain Questionnaire, Neuropathic pain scale, Neuropathic Pain Symptom Inventory, International SCI Pain Basic Data Set, West Haven-Yale Multidimensional Pain Inventory, Brief Pain Inventory, and Douleur Neuropathique 4. These scales highlighted the positive effects of BoNT administration. According to the Jadad scale, all the RCTs included were high-quality studies. BoNT administration might be effectively introduced in the comprehensive management of neuropathic pain. Further research should focus on optimal and cost-effective therapeutic protocols.
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Affiliation(s)
- Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
| | - Arianna Folli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.)
| | - Francesco D’Abrosca
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.)
| | - Elisa Grana
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, 1004 Lausanne, Switzerland; (E.G.); (S.C.)
| | - Alessio Baricich
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.)
- Physical and Rehabilitation Medicine, “Ospedale Maggiore della Carità” University Hospital, 28100 Novara, Italy
| | - Stefano Carda
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, 1004 Lausanne, Switzerland; (E.G.); (S.C.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
- Correspondence: ; Tel.: +39-(0)3-2137-34800
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