O Uso da Toxina Botulínica no Controlo da Dor na Lombalgia

Bruno Guimarães, José Barreto, Inês Táboas, Filomena Melo, Catarina Aguiar-Branco

Resumo


Introdução: A lombalgia é o distúrbio músculo-esquelético mais prevalente, afetando 40%-80% dos indivíduos em todo o mundo, representando um fator de incapacidade major na qualidade de vida e enormes custos para a sociedade. A presente revisão sistemática tem como objetivo refletir sobre a evidência científica que avalia o papel da toxina botulínica (TB) no tratamento da lombalgia.

Métodos: Foi efetuada a revisão da literatura indexada nas bases de dados: Medline (via PubMed), Web of Science e CENTRAL. Para os propósitos do estudo, foram incluídos apenas ensaios clínicos randomizados (RCT), com pelo menos 2 meses de follow-up, tamanho amostral apropriado e cuja qualidade fosse adequada de acordo com os padrões da Delphi List.

Resultados: Nos estudos contemplados, a terapêutica com TB mostrou superioridade no controlo da dor e melhoria da capacidade funcional quando comparada com o placebo. Por outro lado, o tratamento com TB + fisioterapia apresentou maior eficácia versus 1) placebo + fisioterapia e versus 2) terapêutica de infiltrações com corticosteroide & anestésico local (triamcinolona e lidocaína) + fisioterapia, no controlo doloroso da lombalgia.

Conclusão: Apesar dos estudos abordados apontarem o papel relevante que a terapêutica com TB pode apresentar na lombalgia, a consolidação das conclusões encontradas necessita de evidência científica com maior qualidade, nomeadamente de ensaios clínicos randomizados com maior tamanho amostral, com standardização dos outcomes avaliados e protocolos de intervenção detalhados. A terapêutica com TB, integrada numa abordagem multimodal, pode ser uma mais-valia no tratamento da lombalgia.


Palavras-chave


Dor Lombar/tratamento farmacológico; Dor Lombar/reabilitação; Toxina Botulínica/uso terapêutico; Toxina Botulínica Tipo A/uso terapêutico

Texto Completo:

PDF

Referências


Cunha-Miranda L, Carnide F, Lopes MF. Prevalence of rheumatic occupational diseases - PROUD study. Acta Reumatol Port. 2010;35:215-26.

Gouveia N, Rodrigues A, Eusebio M, Ramiro S, Machado P, Canhão H, et al. Prevalence and social burden of active chronic low back pain in the adult Portuguese population: results from a national survey. Rheumatol Int. 2016; 36:183-97.

Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015; 49.

Machado D, Kumar A, Jabbari B. Abobotulinum Toxin A in the Treatment of Chronic Low Back Pain. Toxins. 2016;8:374. doi: 10.3390/toxins8120374

Ney JP, Difazio M, Sichani A, Monacci W, Foster L, Jabbari B. Treatment of chronic low back pain with successive injections of botulinum toxin a over 6 months: a prospective trial of 60 patients. Clin J Pain. 2006; 22:363-9.

Grochowski CO, Cartmill M, Reiter J, Spaulding J, Haviland J, Valea F, et al. Anxiety in first year medical students taking gross anatomy. Clin Anat. 2014;27:835-8. doi: 10.1002/ca.22398.

Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, Baciarello M, Manferdini ME, Fanelli G. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research 2016; 5.

Amirdelfan K, McRoberts P, Deer TR. The differential diagnosis of low back pain: a primer on the evolving paradigm. Neuromodulation. 2014; 17:11-7.

Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010;10:514-29.

Grewal H, Grewal BS, Patel R. Nonsurgical interventions for low back pain. Primary Care. 2012;39:517-23.

National Institute for Health and Care Excellence. Clinical Guidelines: Low Back Pain and Sciatica in Over 16s: Assessment and Management. London: National NICE; 2016.

Chou R, Huffman LH. Evaluation and Management of Low Back Pain. 2011.

Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine 2017.

Gerwin R. Botulinum toxin treatment of myofascial pain: a critical review of the literature. Curr Pain Headache Rep. 2012;16:413-22.

Singh JA. Botulinum toxin therapy for osteoarticular pain: an evidencebased review. Ther Adv Musculoskelet Dis. 2010;2:105-18. doi: 10.1177/1759720X09357113.

Yoon SJ, Song SH, Kim YJ, Kang HY, Lee SH. Biomechanical Evaluation of Refractory Chronic Low Back Pain Treatment with Botulinum Toxin Type A. J Musculoskelet Pain. 2014; 22:152-9.

Godoy IR, Donahue DM, Torriani M. Botulinum toxin injections in musculoskeletal disorders. Semin Musculoskelet Radiol. 2016;20:441-52. doi: 10.1055/s-0036-1594284.

Zhang T, Adatia A, Zarin W, Moitri M, Vijenthira A, Chu R, et al. The efficacy of botulinum toxin type A in managing chronic musculoskeletal pain: a systematic review and meta analysis. Inflammopharmacology. 2011;19:21-34.

Wheeler A, Smith HS. Botulinum toxins: mechanisms of action, antinociception and clinical applications. Toxicology. 2013;306:124-46.

Barbano RL. Botulinum toxins in clinical practice: Gaps in knowledge. Neurol Clin Pract. 2016; 6:206-8.

Durand A, Serment G. Toxines botuliques: utilisation pratique. Ann Readapt Med Phys. 2003;46:386-8. doi: 10.1016/s0168-6054(03)00131-4.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4:1.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015; 349:g7647.

Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998; 51:1235-41.

De Andres J, Adsuara VM, Palmisani S, Villanueva V, Lopez-Alarcon MD. A double-blind, controlled, randomized trial to evaluate the efficacy of botulinum toxin for the treatment of lumbar myofascial pain in humans. Reg Anesth Pain Med. 2010;35:255-60. doi: 10.1097/AAP.0b013e3181d23241.

Fishman LM, Anderson C, Rosner B. BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil. 2002;81:936-42. doi: 10.1097/00002060-200212000-00009.

Foster L, Clapp L, Erickson M, Jabbari B. Botulinum toxin A and chronic low back pain: a randomized, double-blind study. Neurology. 2001;56:1290-3.

Jazayeri SM, Ashraf A, Fini HM, Karimian H, Nasab MV. Efficacy of botulinum toxin type a for treating chronic low back pain. Anesthesiol Pain Med. 2011; 1:77-80.

Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009; 34:1066-77.

Gobel H, Heinze A, Reichel G, Hefter H, Benecke R. Efficacy and safety of a single botulinum type A toxin complex treatment (Dysport) for the relief of upper back myofascial pain syndrome: results from a randomized doubleblind placebo-controlled multicentre study. Pain. 2006;125:82-8.

Nagarajan V, Al-Shubaili A, Ayad YM, Alexander J, Al-Ramezi K. Low back ache treatment with botulinum neurotoxin type A. Local experience in Kuwait. Med Princ Pract. 2007;16:181-6. doi: 10.1159/000100387.

Yoon SJ, Ho J, Kang HY, Lee SH, Kim KI, Shin WG, et al. Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome. Pharmacotherapy. 2007; 27:657-65.

Bakheit AM. The possible adverse effects of intramuscular botulinum toxin injections and their management. Curr Drug Saf. 2006;1:271-9. doi: 10.2174/157488606777934431.

Crowner BE, Torres-Russotto D, Carter AR, Racette BA. Systemic weakness after therapeutic injections of botulinum toxin a: a case series and review of the literature. Clin Neuropharmacol. 2010; 33:243-7.

Bernstein IA, Malik Q, Carville S, Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017, 356:i6748.

Soares A, Andriolo RB, Atallah AN, da Silva EM. Botulinum toxin for myofascial pain syndromes in adults. Cochrane Database Syst Rev. 2014;2014:CD007533. doi: 10.1002/14651858.CD007533.pub3.

Waseem Z, Boulias C, Gordon A, Ismail F, Sheean G, Furlan AD. Botulinum toxin injections for low-back pain and sciatica. Cochrane Database Syst Rev. 2011:CD008257. doi: 10.1002/14651858.CD008257.pub2.




DOI: http://dx.doi.org/10.25759/spmfr.379

Apontamentos

  • Não há apontamentos.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação