Rev. Soc. Esp. Dolor. 2021; 28(6): 332-342 / DOI: 10.20986/resed.2022.3943/2021
Raquel Sepulcre, Rafael Gálvez, Rocío Pozuelo
ABSTRACT
Introduction: An amputation is a devastating event for all patients who suffer it. It introduces significant changes in the patient’s physical, psychic and social spheres. It requires progressive adaptation and reconditioning. Stump pain is one of the most important points in order to control this situation as, on many occasions, it will be what truly determines the patient’s life quality. In the recent years, the usefulness of botulinum toxin was studied for pain treatment with encouraging results.
Objetive: Provide a systematic review on existing scientific literature, with no restrictions on publication year, about the use of botulinum toxin for the pain of amputated patients in order to compile the existing data.
Methodology: Literature was retrieved from PubMed, EMBASE, Cochrane, Clinical Key, Science Direct, Medes, Dialnet, Scielo and Google Schoolar. The only exclusion criterium was studies carried out on non-human. All documents related to the objective of this research were included independently of year, language, sex, age, type of amputation or botulinum toxin. From 1795 studies found after initial research, 19 studies were selected. The levels of evidence are pertained to 2b, degree of recommendation B (2 pilot studies, randomised, double-blind, with control group) and 4C (2 observational and longitudinal prospective studies, 15 clinical cases).
Results: It is estimated that an 80.43 % (74 patients) improvement of stump residual pain and/or of the sensation on the phantom limb and a 65.22 % (60 patients) relief of the phantom limb pain and/or of the residual pain. An absence of change of the phantom limb pain was described by 32 patients (34.7 %) and an absence of relief of residual pain was reported on 18 patients (19.57 %). No studies reflect a deterioration of the disease.
Conclusions: The current study suggests improvement and relief of pain of the phantom limb pain as well as the residual pain in patients treated with botulinum toxin with a 2B level of evidence, degree of recommendation B. Future studies are required to confirm the obtained data.
RESUMEN
Introducción: Una amputación es un suceso demoledor para todo paciente que lo sufre, puesto que presenta un cambio importante, interfiriendo en la esfera física, psíquica y social del individuo, requiriendo una adaptación y reacondicionamiento progresivo. Uno de los puntos más importantes a controlar ante esta situación es el dolor del muñón, puesto que en muchas ocasiones será aquello que realmente determine la calidad de vida del paciente. En los últimos años, se ha estudiado la utilidad de la toxina botulínica para el tratamiento del dolor con resultados esperanzadores.
Objetivo: Realizar una revisión sistemática de la literatura científica existente, sin restricción de año de publicación, sobre el empleo de la toxina botulínica en el dolor de los pacientes amputados, para agrupar los datos existentes.
Métodos: La literatura se extrajo de PubMed, EMBASE, Cochrane, Clinical Key, Science Direct, Medes, Dialnet, Scielo y Google Schoolar. Se definió como único criterio de exclusión estudios realizados en no humanos. Se incluyeron todos los documentos relacionados con el objetivo de la búsqueda, independientemente de año, idioma, sexo, edad, tipo de amputación o toxina botulínica. De los 1795 estudios hallados tras la búsqueda inicial, se seleccionaron 19. Los niveles de evidencia corresponden a 2B, grado de recomendación B (2 estudios piloto, aleatorizados, doble ciego, con grupo control) y 4C (2 estudios observacionales longitudinales prospectivos, 15 casos clínicos).
Resultados: Se estima una mejoría para el dolor residual del muñón ± sensación del miembro fantasma del 80,43 % (74 pacientes) y un alivio del dolor del miembro fantasma ± dolor residual del 65,22 % (60). Se describe una ausencia de modificación del dolor del miembro fantasma para 32 pacientes (34,7 %) y ausencia de alivio del dolor residual en 18 pacientes (19,57 %). En ningún estudio se refleja un empeoramiento de la clínica.
Conclusiones: El presente estudio sugiere una mejora y alivio del dolor del miembro fantasma y del dolor residual, en los pacientes tratados con toxina botulínica con un nivel de evidencia 2B, grado de recomendación B. Son requeridos estudios futuros para confirmar los datos obtenidos.
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