Author/Editor		Gregorič, Milan
Title		Zdravljenje bolečine z botulinom
Translated title		Treatment of pain with botulinum toxin
Type		članek
Source		In: Programme and proceedings 1st Congress of the Slovenian association for pain theraphy and symposium on clinical neurophysiology of pain with the 25th Dr. Janez Faganel memorial lecture with international participation; 2009 Oct 9-10; Bled Ljubljana : Section for Clinical neurophysiology of the Slovenian association
Publication year		2009
Volume		str. 24-31
Language		slv
Abstract		Botulin je živčni strup, ki zavira sproščanje acetilholina na živčnomišičnem stiku in tako hromi mišice. Serološka tipa botulina A (Botox, Dysport) in B (Myobloc/NeuroBloc) uporabljamo klinično za zdravljenje številnih sindromov, predvsem tistih, ki so povezani z žariščno pretirano in nehoteno dejavnostjo mišic pri distoniji in spastičnosti otrok ter odraslih. Sproščanje mišic po botulinski terapiji zmanjšuje tudi bolečine. Klinične izkušnje in podatki raziskav kažejo, da toksin ne deluje na bolečine le prek mišic, ampak tudi na druge, farmakološko in nevrofiziološko še ne povsem pojasnjene načine. Ugotovljeno je tudi ugodno delovanje botulina na bolečine v vratu in križu, medenici, sklepih, pri miofascialnih bolečinskih sindromih, nekaterih sindromih nevropatske bolečine, kompleksnem regionalnem bolečinskem sindromu, primarnem glavobolu in migreni. Protibolečinski učinki botulina pri teh sindromih še niso zanesljivo preverjeni po kriterijih znanstveno utemeljene medicine. Botulinska terapija je učinkovitejša, če jo izvajajo izkušeni strokovnjaki v okviru interdisciplinarne obravnave. Kljub številnim obetavnim podatkom v literaturi širša klinična uporaba toksina za zdravljenje bolečine še ni priporočena.Botulinum neurotoxin inhibits acetylcholine release at the neuromuscular junction resulting in muscle paresis. Serological types A (Botox, Dysport) and B (Myobloc/NeuroBloc) are clinically used in treatment of several syndromes, in particular those related to focal excessive involuntary muscle activity in dystonia and spasticity of adults and children. Muscle relaxation following botulinum treatment gives also oain relief. Clinical experiences and experimental data indicate that botulinum relieves pain not only through muscle relaxation; the analgesic effect may be exerted also by some others not yet completely recognized pharmacological and neurophysiological mechanisms. A beneficial therapeutic effect of botulinum was shown also in neck and low back pain, joint pain, myofascial pain syndromes, selected neuropathic pain syndromes, complex regional pain syndrome and primary headache including migraine. Analgesic effects of botulinum toxin in these syndromes were not completely revealed according to the criteria of the evidence based medicine. Treatment with botulinum is more effective when used by experienced personnel within an interdisciplinary management. In spite of numerous encouraging recent data in literature a widespread clinical use of botulinum would not yet be recommended.
Keywords		botulinum toksin bolečina mišice spastičnost distonija glavobol