Neurobiological basis for the use of botulinum toxin in pain therapy
- Prof. Dr. med. S. Mense
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The “integrated hypothesis” of the formation of myofascial trigger points suggests that a lesion of a muscle damages the endplate so that excessive ACh is released. This causes a local contracture (partial contraction of a muscle fiber) underneath the endplate. The contracture compresses small blood vessels, and the tissue becomes ischemic. Ischemia leads to the release of bradykinin (BKN) and sensitization or excitation of nociceptors. BoNT is a causal therapy in these cases, because it stops the excessive ACh release.
Reflex spasm in a given muscle can be induced by nociceptive input from neighboring joints or muscles. If the force generated by a spasm is relatively high, it will compress the large blood vessels supplying the muscle. The final effect again is ischemia. In this case a drop in pH may accompany the ischemia and BKN release. Protons and BKN are known to be effective stimulants for muscle nociceptors.
In cases of weak dystonias, a compression of blood vessels is unlikely. However, the tonic contraction will cause a lowering of pH and a release of ATP. Muscle cells contain ATP at concentrations sufficient to excite muscle nociceptors. In cases of spasm and dystonia, BoNT can abolish the pain by relaxing the muscle.
- Neurobiological basis for the use of botulinum toxin in pain therapy
Journal of Neurology
Volume 251, Issue 1 Supplement, pp i1-i7
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- muscle pain
- muscle tone
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- Author Affiliations
- 1. Institut für Anatomie und Zellbiologie III, Universität Heidelberg, Im Neuenheimer Feld 307, 69120, Heidelberg, Germany