Botulinum Toxin Treatment of Pain Disorders PDF
7.10 MB PDF
Preface
Very few pharmaceutical agents in medicine have shown efficacy for treatment of so many diverse categories of disorders as botulinum neurotoxins (BoNTs). BoNTs are useful in the treatment of involuntary movements (mostly dystonias), disorders of muscle tone (spasticity), autonomic derangements (sialorrhea and hyperhidrosis), and pain, to name a few. In the latter category, animal studies have provided clear evidence for the analgesic effect of BoNTs through a variety of mechanisms, most notable among them being inhibition of pain mediator release and antiinflammatory effects.
With the emergence of controlled data on the efficacy of onabotulinum toxin A (and, more recently, other neurotoxins) in different kinds of human pain, it became clear that a textbook with updated clinical and research data in this field is needed, and such a book would be of value to both clinicians and researchers. The analgesic effect of BoNTs has been one of my areas of interest for the past 25 years, and I take credit for some of the earlier human studies in this field. At Yale, where I currently practice, several of our ongoing clinical trials are focused on this issue.
The first chapter of this book briefly discusses the molecular structure, toxin types, mode of action, immunology, and side effects of currently available BoNTs. The pathophysiology of human pain, data from animal studies, and studies on the analgesic effects of BoNTs are presented in the second chapter. The following 14 chapters review the literature (mostly from controlled and blinded studies) in different clinical pain disorders. Case reports and video clips are provided from my experience with various disorders to illustrate injection techniques, treatment results, and the relief experienced and described by the patients. The last chapter (Chap. 17 ) briefly addresses new developments and future potentials for BoNT use in the management of pain.
I need to acknowledge the help of several people who were instrumental in the development and completion of this book. Fattaneh Tavassoli, M.D., provided invaluable editorial assistance. Damoun Safarpour, M.D., and Tahereh Moussavi, M.D., provided the artwork and drawings. Douglas Forbush from Yale IT section spent many hours with me to prepare and finalize the videotapes. Manika Power from Springer, who first approached me about the writing of this book, has provided most useful guidance and advice throughout the entire project. Foremost, I am much indebted to the patients who agreed to be videotaped not only for the technical section but also for interviews on the long-term effect of botulinum neurotoxin therapy on their pain.
I hope this book will be of help to the clinicians and researchers alike, ultimately providing better care to our patients suffering from pain.
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