肉毒毒素在治疗慢性腰痛中的应用(英语版)

Evidence based medicine in the use of botulinum toxin for back pain（肉毒毒素在治疗慢性腰痛中的应用）

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Evidence based medicine in the use of botulinum toxin for back pain----肉毒毒素.pdf (283.31 KB, 下载次数: 10, 售价: 2 金币金币)

2013-9-15 21:54 上传

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Summary. Two randomized, prospective studies, one double blind and one open label, longterm evaluated efficacy and safety of Botulinum toxin A (Allergan-Inc) in 31 and 75 patients with chronic low back pain. Both studies used a novel technique imploying 5 level (L1 to L5) injections (40–50 units=level) of BoNT-A into erector spinae muscles. Significant(p<0.05) improvement of pain intensity, frequency and activities of daily living was noted in 60% and 53% of the patients, respectively. The second study also depicted safety with repeated injections over 14 months of follow up. Botulinum toxin-A should be considered for treatment of low back pain when other modes of treatment fail to improve pain.
Keywords: Botulinum toxin A; Botox; low back pain; paraspinal muscles;lumbar spine.

Introduction
Approximately 90% of the general population suffers from low back pain (LBP) during their life time (Wipf and DeReyo 1995). Among patients with acute LBP, 3–7% develops chronic pain that only partially responds to analgesic medications. In the US, back pain is the third most common cause of total work disability, accounting for approximately 40% of all disability compensation costs with a burden (direct and indirect) of $50 billion=year to the economy (Spengler et al. 1986; Frymoyer and Cats-Baril 1991; Krousel-Wod et al. 1994).Treatment of LBP is challenging due to the complexity of low back anatomy and the heterogeneity of causative factors. In mechanical LBP; chronic disc disease, canal stenosis, osteoarthritic changes of the lumbosacral spine,or a combination are common pathologies. Short term relief can be achieved by using non-steroidal analgesic agents, muscle relaxants, opioid analgesics, transcutaneous nerve stimulators (TENS), and certain physical and exercise therapies (Van Tulder et al. 2006). Surgery may help,but has a failure rate of 40%. Massage, behavioral and manipulative therapies, acupuncture, and other modes of treatment produce inconclusive results. Despite availability of multimodal therapies, many patients with chronic LBP express dissatisfaction with their level of pain relief and welcome new modes of treatment.
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对王老师帖子的标题很感兴趣，可惜英语水平有限啊:L