Eficácia da Toxina Botulínica para Tratamento de Dores Crônicas / Efficacy of Botulinum Toxin for Treating Chronic Pain
Resumo
A toxina botulínica é obtida a partir da bactéria Clostridium botulinum, um bacilo Gram-positivo anaeróbico. A substância é popularmente conhecida por possuir capacidade de inibir a liberação do neurotransmissor acetilcolina no terminal nervoso, responsável pela contração muscular. Diante disso, o relaxamento muscular é ocasionado e o ciclo de espasmo-dor é interrompido. Inúmeras pesquisas foram realizadas visando o uso da toxina para o tratamento de dores em pacientes acometidos por determinadas doenças e dores crônicas. Portanto, este estudo propôs verificar a utilização da toxina botulínica do tipo A como recurso terapêutico no tratamento de dores crônicas. A pesquisa, de revisão bibliográfica descritiva com caráter qualitativo, averiguou a eficácia do uso terapêutico da neurotoxina em casos de dor neuropática refratária, vaginismo, enxaqueca, e dor orofacial de origem miofascial. Concluiu-se que a toxina botulínica do tipo A possui elevada capacidade de tratamento paliativo para diversos tipos de dores crônicas, podendo se tornar uma alternativa em casos de dores refratárias a outras terapias convencionais. Entretanto, mais estudos são necessários para a padronização de doses, vias de administração e duração do tratamento.
Palavras-chave: Dor. Toxina Botulínica. Clostridium Botulinum. Tratamento Paliativo.
ABSTRACT
The botulinum toxin is obtained from the bacteria Clostridium botulinum, which is an anaerobic Gram-positive bacillus. It is popularly known for the ability to inhibit the release of the acetylcholine neurotransmitter in the nerve terminal, which is responsible for muscle contraction. As a result, the muscle relaxes, and the spasm-pain cycle is interrupted. Numerous research were conducted focusing on the botulinum toxin as pain treatment in patients suffering from certain diseases and chronic pain. Therefore, this study proposed to verify the use of botulinum toxin type A as a therapeutic resource in the treatment of chronic pain. This qualitative literature review investigated the therapeutic effectiveness of the botulinum toxin in cases of refractory neuropathic pain, vaginismus, migraine, and orofacial pain from myofascial conditions. The botulinum toxin type A has high capacity as a palliative treatment for several types of chronic pain and may be an alternative in cases of pain unresponsive to other conventional therapies. However, further studies should be conducted to standardize doses, routes of administration, and treatment duration.
Keywords: Pain; Botulinum Toxin. Clostridium Botulinum. Palliative Treatment.
Palavras-chave
Referências
BLUMENFELD, A., SILBERSTEIN, S.D., DODICK, D.W., AURORA, S.K., TURKEL, C.C. AND BINDER, W.J. Method of Injection of OnabotulinumtoxinA for Chronic Migraine: A Safe, Well-Tolerated, and Effective Treatment Paradigm Based on the PREEMPT Clinical Program. Headache: The Journal of Head and Face Pain, 50: 1406-1418; 2010.
BRIN, M. F., & VAPNEK, J. M. Treatment of vaginismus with botulinum toxin injections. Lancet (London, England), 349(9047), 252–253; 1997.
CHECHETTO, ALL et al. AVALIAÇÃO DOS BENEFÍCIOS DO TRATAMENTO DA DOR OROFACIAL CAUSADA PELA HIPERTROFIA DOS MÚSCULOS MASSETER E TEMPORAL COM O USO DA TOXINA BOTULÍNICA: evaluation of orofacial pain treatment benefits of hypertrophy caused by masseter and temporalis muscles with the use toxin botulinum. Revista Uningá Review, v. 24, n. 3, p. 11-14, 8; 2015.
CROFFORD LJ. Chronic Pain: Where the Body Meets the Brain. Trans Am Clin Climatol Assoc. 126:167–83; 2015.
COLHADO, OCG et al. Toxina Botulínica no Tratamento da Dor: botulinum toxin in pain treatment. Revista Brasileira de Anestesiologia, v. 59, n. 3, p. 366-381, 2009.
DATTA GUPTA A, EDWARDS S, SMITH J, SNOW J, VISVANATHAN R, TUCKER G, WILSON D. A Systematic Review and Meta-Analysis of Efficacy of Botulinum Toxin A for Neuropathic Pain. Toxins. 14(1):36; 2022.
DESAI SA, SHAH B, KROUMPOUZOS G. Botulinum toxin treatment of refractory vaginismus: a prospective study. International Journal of Women’s Dermatology. 10(4):p e186, 2024.
DI FRANCESCO F, LANZA A, DI BLASIO M, VAIENTI B, CAFFERATA EA, CERVINO G, CICCIÙ M, MINERVINI G. Application of Botulinum Toxin in Temporomandibular Disorders: A Systematic Review of Randomized Controlled Trials (RCTs). Applied Sciences. 12(23):12409; 2022.
DWORKIN SF. Temporomandibular Disorder (TMD) Pain–Related Disability Found Related to Depression, Nonspecific Physical Symptoms, and Pain Duration at 3 International Sites. J Evid Based Dent Pract. 11(3):143–4; 2011.
EIGENBRODT, A.K., ASHINA, H., KHAN, S. et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol, 17, 501–514; 2021.
ERBGUTH, F. From poison to remedy: the chequered history of botulinum toxin. J Neural Transm, 115, 559–565; 2008.
FRANK, F., ULMER, H., SIDOROFF, V., & BROESSNER, G. CGRP-antibodies, topiramate and botulinum toxin type A in episodic and chronic migraine: A systematic review and meta-analysis. Cephalalgia: an international journal of headache, 41(11-12), 1222–1239; 2021.
HARY, V., SCHITTER, S., & MARTINEZ, V. Efficacy and safety of botulinum A toxin for the treatment of chronic peripheral neuropathic pain: A systematic review of randomized controlled trials and meta-analysis. European Journal of Pain, 26, 980–990; 2022.
HENIEN M, MAHENDRAN K, AL-SARRAJ M, ROWE S, MACIAG A. Botulinum Toxin A for the management of temporomandibular myofascial pain - a cohort study. British Journal of Oral and Maxillofacial Surgery, 2024.
HELMI, Zeena R. et al. Comparative Study of 150 vs. 200 Units of Botulinum Toxin as Treatment for Vaginismus. Revista Brasileira de Ginecologia e Obstetrícia / Rbgo Gynecology And Obstetrics, v. 44, n. 09, p. 854-865, 2022.
JADHAO, V. A., LOKHANDE, N., HABBU, S. G., SEWANE, S., DONGARE, S., & GOYAL, N. Efficacy of botulinum toxin in treating myofascial pain and occlusal force characteristics of masticatory muscles in bruxism. Indian journal of dental research: official publication of Indian Society for Dental Research, 28(5), 493–497, 2017.
MARTINELLI D, ARCERI S, DE ICCO R, et al. BoNT-A efficacy in high frequency migraine: an open label, single arm, exploratory study applying the PREEMPT paradigm. Cephalalgia.42(2):170-175; 2022.
MESSIAS, CR et al. Dor Crônica, Depressão, Saúde Geral e Suporte Social em Pacientes Fibromiálgicos e Oncológicos: chronic pain, depression, general health and social support in fibromyalgic and oncological patients. Revista Psicologia e Saúde, v. 12, n. 4, p. 41-51, dez. 2020.
MOLAEI A, HEMMATI M, IZADI S, PAKNAZAR F, SHAKERI S, HEMMATI H. Response to treatment with Botulinum toxin-A in patients with Refractory Chronic Migraine. Iran South Med J, 27 (1) :1-12; 2024.
MOREIRA, Ramon Luiz Braga Dias. Vaginismo: vaginismus. Revista Médica de Minas Gerais, v. 23, n. 3, p. 336-342, 2013.
OLIVEIRA KM, BARRETO ESR, ALENCAR VB, LINS-KUSTERER LEF, AZI LMT DE A, KRAYCHETE DC. The efficacy of botulinum toxin in neuropathic pain: a systematic review. British Journal of Pain. 18(5):388-402; 2024.
RAJA SN, CARR DB, COHEN M, FINNERUP NB, FLOR H, GIBSON S, KEEFE FJ, MOGIL JS, RINGKAMP M, SLUKA KA, SONG XJ, STEVENS B, SULLIVAN MD, TUTELMAN PR, USHIDA T, VADER K. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain.161(9):1976–82; 2020.
SANTOS, LO et al. O USO DA TOXINA BOTULÍNICA COMO TRATAMENTO PALIATIVO NA DOR MIOFASCIAL: the toxin use botulinum as palliative treatment in pain myofascial. Brazilian Journal Of Surgery And Clinical Research: BJSCR, v. 16, n. 1, p. 60-65, 2016.
SEWANE, S et al. Efficacy of botulinum toxin in treating myofascial pain and occlusal force characteristics of masticatory muscles in bruxism. Indian Journal Of Dental Research, v. 28, n. 5, p. 493, 2017.
SHATERIAN, N., SHATERIAN, N., GHANAATPISHEH, A., ABBASI, F., DANIALI, S., JAHROMI, M. J., SANIE, M. S., & ABDOLI, A. Botox (OnabotulinumtoxinA) for Treatment of Migraine Symptoms: A Systematic Review. Pain research & management, 3284446; 2022.
SOUSA, Emanuel de Jesus Soares de et al. Botulinum toxin type A in chronic neuropathic pain in refractory leprosy. Arquivos de Neuro-Psiquiatria, v. 77, n. 5, p. 346-351, 2019.
VAL M, DELCANHO R, FERRARI M, GUARDA NARDINI L, MANFREDINI D. Is Botulinum Toxin Effective in Treating Orofacial Neuropathic Pain Disorders? A Systematic Review. Toxins. 15(9):541; 2023.
VELAYATI A, SHAHIDEH JS, SAEIDEH Z, KAZEMNEJAD A. Can Botox Offer Help Women With Vaginismus? A Systematic Review and Meta-Analysis. International Journal of Sexual Health. 31. 233-243; 2019.
DOI: http://dx.doi.org/10.12819/rsf.2023.10.2.2
Apontamentos
- Não há apontamentos.
Revista Saúde em Foco N° 1/2014