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Licensed Unlicensed Requires Authentication Published by De Gruyter March 27, 2019

Pain in cervical dystonia and the antinociceptive effects of botulinum toxin: what is currently known?

  • Michał Marciniec EMAIL logo , Anna Szczepańska-Szerej , Marcin Kulczyński , Klaudia Sapko , Sylwia Popek-Marciniec and Konrad Rejdak


Pain is the most common and disabling non-motor symptom in cervical dystonia (CD). Up to 88.9% of patients report pain at some point in the course of the disease. It is still a matter of debate whether CD-related pain originates only from prolonged muscle contraction. Recent data suggest that the alterations of transmission and processing of nociceptive stimuli play a crucial role in pain development. Botulinum toxin (BT) is the first-line therapy for CD. Despite fully elucidated muscle relaxant action, the antinociceptive effect of BT remains unclear and probably exceeds a simple decompression of the nerve fibers due to the reduction in muscle tone. The proposed mechanisms of the antinociceptive action of BT include inhibition of pain mediator release, inhibition of membrane sodium channels, retrograde axonal transport and impact on the other pain pathways. This article summarizes the current knowledge about the antinociceptive properties of BT and the clinical analgesic efficacy in the treatment of CD patients.


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Received: 2018-12-29
Accepted: 2019-01-25
Published Online: 2019-03-27
Published in Print: 2019-10-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

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