Efectos de la toxina botulínica A (Botox®) intraarticular en la artrosis de rodilla avanzada / No disponible

Objetivos: la osteoartritis es la enfermedad articular más común y una de los problemas de salud más frecuentes y sintomáticos en la madurez y senectud. Este trabajo describe nuestra experiencia clínica con inyecciones intraarticulares de toxina botulínica tipo A (TBA) en dolor de rodilla artrósico y refractario. Materiales y métodos: doce mujeres con gonartrosis avanzada y refractaria, acudieron a consulta para el manejo del dolor de rodilla de moderado a severo. Las pacientes estuvieron en seguimiento 16 semanas, durante las que la mejoría de su estado fue valorado comparando el dolor basal respecto al dolor en el momento de la visita mediante diferentes escalas estandarizadas. Simultáneamente, se evaluaron la funcionalidad, la cantidad de medicación analgésica diaria y los efectos secundarios. Resultados: el consumo de medicación decreció de 3,6 a 2 tomas/día. No se observaron efectos secundarios. Conclusión: se evidenció un alivio del dolor que se inició en la semana 2 y se mantuvo hasta 12 semanas tras la inyección de TBA. La mediana del cambio de la escala total de WOMAC y de la EVA fue de –7,5 y –1,9 respectivamente, con una disminución significativa del dolor a las 16 semanas. No se registraron cambios en la escala WOMAC en 5 pacientes, mientras que 3 casos mostraron un descenso en dicha escala mayor del 20% y los en los 4 restantes fue superior al 40%. Las que respondieron a la infiltración notaron una mejora en las actividades de la vida diaria gracias a este alivio. El consumo de medicación decreció de 3,6 a 2 tomas/ día. No se observaron efectos secundarios (AU)

Objective: osteoarthritis is the most common joint disease and it is among the most disabling health problems for middle aged and older people. Purpose: to test the effects of a single intraarticular injection of Botulinum Toxin A (BTA) on refractory knee osteoarthritis. Material and method: twelve women (mean age: 72) with refractory knee osteoarthritis who had failed other treatments and without possibilities of arthroplasty were injected with 100 units of BTA (Botox®-Allergan). Patients were followed-up for 16 weeks. They were assessed by means of VAS, WOMAC questionnaire, daily analgesic consumption, and a verbal relief scale. Side effects were also evaluated. Results: a peak of pain relief was evident 2 weeks after BTA injection and lasted typically for 16 weeks. The median change in WOMAC total score and VAS were –7.5 and –1.9 respectively, with a statistically significant pain decrease over 16 weeks. Five out of 12 do not found any decrease in total Womac score; 3 patients described at least 20% of relief and the remaining 4 found more than 40% of reduction in that scale. Those cases who responded to the BTA injection noted improved function in activities of daily living. Daily analgesic necessity droped from 3.6 to 2 doses. No side effects were noted. Conclusion: beneficial effects lasted for at least 12 weeks and gave pain relief. Based on the positive findings of this study, we believe that further, randomized, controlled trials for the use of BTA in knee osteoarthritic pain would be warranted (AU)

[Effectiveness and safety of oxcarbazepine in chronic neuropathic pain: a study of 40 cases]. / Eficacia y tolerabilidad de oxcarbacepina en dolor neuropático crónico: estudio de 40 casos.

INTRODUCTION: Neuropathic pain (NP) often fails to respond to the commonly established analgesic treatment. This fact, together with the existence of side effects, has led to the need to evaluate the analgesic effectiveness of antiepileptic drugs, which, as in the case of oxcarbazepine (OXC), are a valid alternative. AIMS: The aim of this study was to evaluate the effectiveness and safety of OXC in patients suffering from chronic NP. PATIENTS AND METHODS: We conducted a prospective, open study involving a series of 40 patients diagnosed with a long history of NP, which was previously resistant to different kinds of treatment with anticonvulsants, non-steroidal anti-inflammatory (NSAI) drugs, opiates and adjuncts. Patients were treated with OXC and they were evaluated in both the basal (prior to treatment) and final visits (after treatment) by means of the visual analogue scale (VAS), SF-McGill questionnaire and the Lattinen test. The patient's general impression of the result was also obtained. The statistical analysis was performed by calculating the "effect size", by computing Cohen's d. RESULTS: Treatment with OXC diminishes different symptomatic variations of this pain, but especially so in the case of lancinating discharges (d = 0.87, important effect) and burning pain (d = 0.60, moderate-important effect), although the allodynia (d = 0.48, moderate effect) also improved with treatment. In the opinion of the patients themselves, response to treatment was good or very good in 50% of cases. The chief side effects observed were dizziness, drowsiness and abdominal upsets. CONCLUSIONS: OXC can be seen as a therapeutic alternative to be taken very much into account in patients with NP having different aetiologies; it has a good benefit-risk ratio and is a form of treatment that is well accepted by patients.

Eficacia y tolerancia de la oxcarbacepina en dolor neuropático crónico: estudio de 40 casos / Effectiveness and safety of oxcarbazepine in chronic neuropathic pain: a stuy of 40 cases

ntroduction. Neuropathic pain (NP) often fails to respond to the commonly established analgesic treatment. This fact, together with the existence of side effects, has led to the need to evaluate the analgesic effectiveness of antiepileptic drugs, which, as in the case of oxcarbazepine (OXC), are a valid alternative. Aims. The aim of this study was to evaluate the effectiveness and safety of OXC in patients suffering from chronic NP. Patients and methods. We conducted a prospective, open study involving a series of 40 patients diagnosed with a long history of NP, which was previously resistant to different kinds of treatment with anticonvulsants, non-steroidal anti-inflammatory (NSAI) drugs, opiates and adjuncts. Patients were treated with OXC and they were evaluated in both the basal (prior to treatment) and final visits (after treatment) by means of the visual analogue scale (VAS), SF-McGill questionnaire and the Lattinen test. The patient’s general impression of the result was also obtained. The statistical analysis was performed by calculating the ‘effect size’, by computing Cohen’s d. Results. Treatment with OXC diminishes different symptomatic variations of this pain, but especially so in the case of lancinating discharges (d = 0.87, important effect) and burning pain (d = 0.60, moderate-important effect), although the allodynia (d = 0.48, moderate effect) also improved with treatment. In the opinion of the patients themselves, response to treatment was good or very good in 50% of cases. The chief side effects observed were dizziness, drowsiness and abdominal upsets. Conclusions. OXC can be seen as a therapeutic alternative to be taken very much into account in patients with NP having different aetiologies; it has a good benefit-risk ratio and is a form of treatment that is well accepted by patients (AU)

Introducción. La falta de respuesta del dolor neuropático (DN) a tratamientos analgésicos habituales o la existencia de efectos adversos, ha hecho recomendable evaluar la eficacia analgésica de los fármacos antiepilépticos que, como en el caso de la oxcarbacepina (OXC), son una alternativa válida. Objetivo. Evaluar la eficacia y tolerabilidad de la OXC en pacientes con DN crónico. Pacientes y métodos. Estudio abierto, prospectivo, de una serie de 40 pacientes diagnosticados de DN de larga evolución, previamente refractario a diferentes tratamientos con anticomiciales, antiinflamatorios no esteroideos (AINE), opiáceos y coadyuvantes. Los pacientes se trataron con OXC y se evaluaron en las visitas basal (antes del tratamiento) y final (después del tratamiento) por medio de una escala visual analógica (EVA), escalas de McGill-SF y cuestionario de Lattinen. También se obtuvo la impresión general del resultado por parte del paciente. El análisis estadístico se realizó mediante el cálculo del ‘tamaño del efecto’ (effect size), computando la d de Cohen. Resultados. El tratamiento con OXC consigue disminuir diferentes variantes sintomáticas de este dolor, pero especialmente las descargas lancinantes (d = 0,87, efecto grande) y el dolor urente (d = 0,60, efecto moderado-grande), aunque también la alodinia (d = 0,48, efecto moderado) mejora con el tratamiento. En opinión de los propios pacientes, la respuesta al tratamiento ha sido buena o muy buena en un 50% de ellos. Los principales efectos secundarios observados fueron mareos, somnolencia y molestias abdominales. Conclusiones. La OXC puede considerarse como una alternativa terapéutica a tener muy en cuenta en pacientes con DN de diferentes etiologías, presenta una buena relación beneficio-riesgo y es un tratamiento bien aceptado por los pacientes (AU)