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Case Report-Successful Treatment of Brush-evoked Pain Induced after Herpes Zoster by Trigger Point Injections with Botulinum Toxin A


台灣疼痛醫學雜誌第29卷第1期(2011-09-01)
 陳怜文(Ling-Wen Chen);陳貞吟(Jen-Yin Chen);曾劍英(Jann-Inn Tzeng);劉哲安(Che-An Liu);馮炳勳(Ping-Hsun Feng)
摘要
Postherpetic neuralgia (PHN) is a common peripheral neuropathic pain syndrome. Current treatments for neuropathic pain include pharmacological and non-pharmacological management. Non-pharmacological treatments which are not the mainstay therapeutic options should be considered to manage subtypes of patients who are refractory to medications or intolerant of the side effects of drugs. Herein, we report a 58 year-old female patient suffered from persistence of pain symptoms involving the right forth to seventh cervical roots for 4 months. The pain didn't respond well to low-dose medications. She was intolerant of the side effects of high-dose drugs. Physical examinations revealed both brush-evoked pain and myofascial trigger points on her neck, shoulder and upper arm. The pain manifestations of her PHN were comprised of sensory neuralgia and myofascial pain. Analgesic properties of Botulinum toxin A (BTX-A) have demonstrated to be beneficial in myorelaxation and have multiple effects on the sensory nervous system. Therefore, we used trigger point blocks with BTX-A once to relieve her pain successfully without recurrence of pain during the one year follow up. To our knowledge, this is the first case of brush-evoked pain induced after herpes zoster combined with myofascial pain successfully treated by trigger point injections with BTX-A. Furthermore, the duration of pain-free time compared to intradermal or subcutaneous injections was substantially greater. However,further large-scale studies are needed to replicate this clinical observation.
並列摘要
帶狀皰疹後神經痛是帶狀皰疹後常見的併發症,它是一種慢性周邊神經性疼痛。疼痛的原因被發現不單只是神經痛,還包括肌筋膜疼痛。藥物治療是帶狀皰疹後神經痛目前主要的治療方法。但是對於那些藥物治療反應不佳或無法忍受其副作用的帶狀皰疹後神經痛的病患,必須考慮使用非藥物的治療。我們在此報告一個侵犯頸椎神經的帶狀皰疹後神經痛病例,她不僅對於藥物治療效果不佳且無法忍受藥物副作用。在這病患神經痛的區域內,我們同時發現了觸摸痛與肌膜激痛點。觸摸痛為神經痛主要特徵之一,而肌膜激痛點則是肌筋膜痛主要特點。根據肉毒桿菌素具有對神經痛及肌筋膜痛的雙重止痛機轉,我們嘗試以肉毒桿菌素注射於激痛點來治療這位病患,結果成功地治療此病患之疼痛,且止痛的效果比經皮內或皮下注射的方式更持久。就我們所知,這是第一篇以肉毒桿菌素注射於肌筋激痛點且成功地治療帶狀皰疹後刷誘疼痛的病例報告。

 

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