Uso de toxina botulínica tipo A en el manejo de dolor crónico refractario a tratamiento. Reporte de una serie de casos. / Use of botulinum toxin type A in the management of chronic pain refractory to treatment. Report a series cases

ABSTRACT

Botulinum toxin type A (BTA) has analgesic effect independent of its action in muscle tone, inhibiting the release of neurotransmitters (substance P-glutamate) and neuropeptides of nociceptors. Objective: To characterize infiltration procedures with Botox® in patients with chronic pain refractory to treatment. Method: Observational-cross-retrospective study. Infiltrations with botox procedures performed in Hospital Clínico Mutual de Seguridad, between 01.01.2014 and 30.04.2015 were analyzed. Medical record data were extracted. Information analyzed with Excel2013® using Chi-square test (p <0.05). Results: 31 patients treated, 83.9 percent male. Average age 51 years (SD ± 11.9yo). Diagnostics causes of pain post-traumatic pain and myofascial syndrome (25.8 percent); complex regional pain syndrome (16.1 percent) and partial hand amputation (12.9 percent). Predominant type of pain neuropathic pain (64.5 percent). Common procedures median nerve blockade (21.2 percent) and infiltration of lumbar back trigger points (15.4 percent). 77.4 percent reported good pain control, crisis decreased 74.2 percent and 71 percent decreases opioid use. Return work was effective in 64.5 percent of patients. 93.6 percent satisfactorily tolerated the procedure, 9.7 percent showed fewer adverse effects. The subgroup neuropathic pain had significantly worse results regarding mixed pain subgroup (p <0.05). Discussion: In this study, the use of BTA in chronic pain proved to be a safe and effective procedure for the management of chronic musculoskeletal pain...