Journalartikel

Jahr der Veröffentlichung: 2017

Seiten: 1326-1335

Zeitschrift: European Journal of Pain

Bandnummer: 21

Heftnummer: 8

ISSN: 1090-3801

eISSN: 1532-2149

DOI Link: https://doi.org/10.1002/ejp.1031

Verlag: Wiley

Abstract: 

BackgroundThe effectiveness of Botulinum-neurotoxin A (BoNT/A) to treat pain in human pain models is very divergent. This study was conducted to clarify if the pain models or the route of BoNT/A application might be responsible for these divergent findings.

MethodsSixteen healthy subjects (8 males, mean age 275years) were included in a first set of experiments consisting of three visits: (1) Visit: Quantitative sensory testing (QST) was performed before and after intradermal capsaicin injection (CAPS, 15g) on one thigh and electrical current stimulation (ES, 1Hz) on the contralateral thigh. During stimulation pain and the neurogenic flare response (laser-Doppler imaging) were assessed. (2) Four weeks later, BoNT/A (Xeomin((R)), 25MU) was injected intracutaneously on both sides. (3) Seven days later, the area of BoNT/A application was determined by the iodine-starch staining and the procedure of the (1) visit was exactly repeated. In consequence of these results, 8 healthy subjects (4 males, mean age 263years) were included into a second set of experiments. The experimental setting was exactly the same with the exception that stimulation frequency of ES was increased to 4Hz and BoNT/A was injected subcutaneously into the thigh, which was stimulated by capsaicin.

ResultsBoNT/A reduced the 1Hz ES flare size (p<0.001) and pain ratings (p<0.01), but had no effect on 4Hz ES and capsaicin-induced pain, hyperalgesia, or flare size, regardless of the depth of BoNT/A injection (i.c./s.c). Moreover, i.c. BoNT/A injection significantly increased warm detection and heat pain thresholds in naive skin (WDT, 2.2 degrees C, p<0.001; HPT 1.8 degrees C, p<0.005).

ConclusionBoNT/A has a moderate inhibitory effect on peptidergic and thermal C-fibers in healthy human skin.

SignificanceThe study demonstrates that BoNT/A (Incobotulinumtoxin A) has differential effects in human pain models: It reduces the neurogenic flare and had a moderate analgesic effects in low frequency but not high frequency current stimulation of cutaneous afferent fibers at C-fiber strength; BoNT/A had no effect in capsaicin-induced (CAPS) neurogenic flare or pain, or on hyperalgesia to mechanical or heat stimuli in both pain models. Intracutaneous BoNT/A increases warm and heat pain thresholds on naive skin.

Harvard-Zitierstil: Diener, S., Breimhorst, M., Vogt, T., Kraemer, H., Drummond, P., Geber, C., et al. (2017) Differential effect of Incobotulinumtoxin A on pain, neurogenic flare and hyperalgesia in human surrogate models of neurogenic pain, European Journal of Pain, 21(8), pp. 1326-1335. https://doi.org/10.1002/ejp.1031

APA-Zitierstil: Diener, S., Breimhorst, M., Vogt, T., Kraemer, H., Drummond, P., Geber, C., & Birklein, F. (2017). Differential effect of Incobotulinumtoxin A on pain, neurogenic flare and hyperalgesia in human surrogate models of neurogenic pain. European Journal of Pain. 21(8), 1326-1335. https://doi.org/10.1002/ejp.1031