ABSTRACT
<p>Introduction: Lidocaine has an analgesic effect by inhibitory action for peripheral nervous system. It is effective for the refractory pain of neuropathic, even a high amount of opioid injection may not relieve pain, resulting in neuropathic cancer pain or adverse effects of morphine. Case Report: A 51-year-old woman had esophageal cancer with severe refractory pain of neuropathic. The pain was not relieved by increasing the dose of opioid because of adverse effects and morphine intolerance. Continuous lidocaine infusion decreased the frequency and the extent of pain and the dose of opioid. The patient didn’t show any symptoms of an adverse effect by this lidocaine treatment. Conclusion: This treatment may be useful for refractory pain of neuropathic in a patient having morphine intolerance with terminal phase.</p>
ABSTRACT
Botulinum toxin type A (BT-A) has been described as an important strategy to various types of pain such as cervical dystonia, myofascial pain syndrome and headache. Although BT-A efficacy has not been proven in tension type headache, its use in migraine continues controversial. In this open trial, we evaluated the efficacy of BT-A in refractory migraine. BT-A was injected in patients diagnosed with migraine who had previously used three classes of prophylactic drugs by at least one year with no response. The most important improvement was observed within 30 days, but pain intensity and frequency of headache had been decreased until the end of three months of follow up. Side effects of BT-A were mild and self limited. We conclude that BT-A seems to be a safe and effective treatment to refractory migraine patients.
Toxina botulínica tipo A (TB-A) tem sido descrita como importante estratégia para diversos tipos de dor como cefaléia e dores relacionadas a distonia cervical ou síndrome miofascial. Embora a eficácia da TB-A não tenha sido demonstrada na cefaléia do tipo tensional, seu uso na enxaqueca continua controverso. Nesse estudo avaliamos a eficácia da TB-A na enxaqueca refratária. TB-A foi injetada em pacientes com enxaqueca que fizeram tratamento prévio com no mínimo três classes de medicamentos profiláticos, sem resultados satisfatórios. A melhora mais significativa dos pacientes foi observada após 30 dias de aplicação de TB-A, enquanto intensidade da dor e freqüência de cefaléia continuaram reduzidas até o final de três meses de seguimento. Os efeitos colaterais observados após a aplicação de TB-A foram moderados e auto-limitados. Os nossos dados mostram que TB-A parece ser um tratamento seguro e eficaz para pacientes com enxaqueca refratária.