The Clinical journal of pain
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Botulinum toxin is approved for the treatment of muscle overactivity associated with several disorders, such as dystonias. However, control of muscle spasm often results in pain relief as well. Effective relief of pain associated with myofascial pain syndrome provides a model for the use of botulinum toxin to relieve pain associated with other types of soft-tissue syndromes, such as fibromyalgia. ⋯ Several studies have demonstrated the efficacy of botulinum toxin types A and B in treating several neuropathic pain disorders. Proper patient selection, injection technique, and dosing are critical to obtaining the best outcomes in managing pain with botulinum toxin. Additional study is needed to better characterize its use for the treatment of pain.
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Temporomandibular disorder (TMD) is a collective term used to characterize a heterogeneous group of conditions involving the temporomandibular joint (TMJ) and its contiguous tissues. Although the pathologies behind TMDs have not been completely explained, the symptoms associated with these disorders are similar and are most commonly manifest as pain in the orofacial region. ⋯ This article describes common TMDs and their treatment with botulinum toxin. Dosing guidelines and illustrations of affected muscles and target injection sites are provided.
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Randomized Controlled Trial Comparative Study Clinical Trial
Lack of both sex differences and influence of resting blood pressure on muscle pain intensity.
To test whether muscle pain intensity caused by different intensities of unaccustomed eccentric exercise was moderately and negatively associated with resting blood pressure, and whether women reported higher pain ratings compared with men in response to such exercise. ⋯ The negative findings, contrary to those predicted from previous experiments in which other types of noxious stimuli have been used, suggest that sex and blood pressure associations with pain intensity are stimulus dependent.
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An overview is presented of neuropathic pain syndromes, their characteristic symptoms and signs, and recent approaches to identifying their pathophysiologic mechanisms. ⋯ Precise estimates of the prevalence of neuropathic pain are not available, but chronic neuropathic pain may be much more common than has generally been appreciated and its prevalence can be expected to increase in the future. There is considerable agreement that both peripheral and central processes contribute to many chronic neuropathic pain syndromes, and that these different mechanisms may explain the qualitatively different symptoms and signs that patients experience. The limitations of existing treatments for neuropathic pain and the inability to provide relief for many patients has stimulated ongoing studies that examine different approaches to preventing neuropathic pain.
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The immune system is unable to determine whether material it encounters is deleterious, benign, or even beneficial to the organism. This presents a significant challenge when protein-based biological therapies, such as botulinum toxin, are administered to patients. Many factors combine to influence the likelihood and the magnitude of an immune response if a response is elicited. ⋯ The majority of anti-toxin antibodies do not affect its function. Finally, although crossreactivity has been reported among the seven botulinum toxin serotypes, non-neutralizing antibodies are present that recognize regions of similarity among the serotypes. No cross-neutralizing antibodies have been described in patients administered any of the toxin serotypes.