Optimization of pain management in cervical dystonia

Marciniec Michał, Szczepańska-Szerej Anna, Kulczyński Marcin, Sapko Klaudia, Rejdak Konrad. Optimization of pain management in cervical dystonia. Journal of Education, Health and Sport. 2018;8(8):249-264. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1307288 http://ojs.ukw.edu.pl/index.php/johs/article/view/5637 https://pbn.nauka.gov.pl/sedno-webapp/works/869874 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2018; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 25.06.2018. Revised: 28.06.2018. Accepted: 08.07.2018. Optimization of pain management in cervical dystonia Michał Marciniec1, Anna Szczepańska-Szerej1, Marcin Kulczyński1, Klaudia Sapko*1, Konrad Rejdak1 1Chair and Department of Neurology, Medical University of Lublin, Poland * E-mail address: klaudia.sapko@gmail.com ABSTRACT Cervical dystonia (CD) is the third most common movement disorder characterized by sustained or intermittent muscle contractions causing abnormal movements, postures, or both. Pain in the course of CD is a frequent symptom reported by the 54.6% - 88.9% of patients, which strongly affects the disability and quality of life, and is the most common reason patients are looking for treatment. Despite the main effect of botulinum toxin (BoNT) is muscle relaxation through the inhibition of the acetylcholine release at the neuromuscular junction, the analgesic effect of BoNT is probably attributed to the acting on central nervous system. Up to 20% of patients discontinue therapy due to treatment failure or adverse effects. Most poor responses are related to suboptimal treatment and a minority to immunoresistance which currently concerns only 0-2,5% of CD cases. In case of confirmed immunoresistance to BoNT-A standard therapy, the use of BoNT-B or alternative BoNT-A is recommended. The currently available management of improving the analgesic efficacy of first-line treatment in patients without immunoresistance includes: the eradication of BoNT adverse events, the determination of individual BoNT dosage, reviewing injections technique with electromyography or ultrasound guidance, the implementation of a rehabilitation program and the applying of the invasive or non-invasive brain stimulation methods. However, due to the lack of evidences from the large, randomized, controlled, clinical trials, an issuance of unambiguous recommendations remains difficult. Further studies on a poor response to BoNT injections and analgesic effects of above methods in the treatment of the CD-related pain are needed. Keywords: Cervical Dystonia, Torticollis, Pain, Botulinum Toxins