Botox in post-herpetic neuralgia_action mechanism in dorsal horn of spinal cord , part 5
Автор: Practical Pain Management with Dr. Lee
Загружено: 2025-04-19
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The botulinum toxin has been used in postherpetic neuralgia for 15 years since it was published in pain medicine in December 2010.
In this randomized, double-blind, placebo-controlled trial, researchers assessed the efficacy of subcutaneous botulinum toxin-A injections in patients suffering from postherpetic neuralgia. The study found that patients receiving botulinum toxin-A -experienced significantly reduced pain intensity and improved sleep quality compared to those receiving lidocaine or placebo injections. Additionally, the botulinum toxin-A group demonstrated a lower reliance on opioid medications. These findings suggest that subcutaneous botulinum toxin-A injections can be an effective treatment option for managing postherpetic neuralgia.
This lecture aims to enhance understanding of the mechanism of botox in chronic pain, including chronic postherpetic neuralgia.
Traditionally, botulinum toxin has been used at the neuromuscular junction to achieve localized muscle paralysis.
Botox exerts its effects at the neuromuscular junction by first binding specifically to receptors on presynaptic cholinergic nerve terminals, followed by internalization via endocytosis and translocation of its enzymatic light chain into the cytoplasm, where it cleaves SNARE proteins essential for neurotransmitter release, thereby preventing acetylcholine-containing vesicles from fusing with the presynaptic membrane, blocking neurotransmitter release, and ultimately causing muscle paralysis; similarly, in secretory glands, Botox binds to cholinergic nerve terminals, cleaves SNARE proteins to inhibit acetylcholine release, and reduces glandular secretion by decreasing muscarinic receptor activation.
Understanding how Botox works is more complex in the central nervous system than at the neuromuscular junction. A major challenge lies in uncovering its mechanism of action in neurotransmission within lamina II of the spinal cord and identifying where and how it is absorbed following injection. To address this, we need to explore the various neurotransmitters and neuropeptides active in the spinal cord—particularly those involved in the intricate signaling of lamina II.
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