Nadiya Segin, Roman Smolynets, Joana Barroso, Natalia Molinets, Paul F Pasquina, Steven P Cohen
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引用次数: 0
Abstract
Objectives: To determine the comparative-effectiveness of botulinum toxin (BT) injections vs. comprehensive medical and surgical treatment (CMST) for war-related postamputation pain.
Design: Prospective, comparative-effectiveness study evaluating outcomes in patients treated with BT or CMST in 2 Ukrainian hospitals.
Participants: Patients with at least 2 out of 10 residual (RLP) or phantom (PLP) limb pain were included.
Interventions: In the BT group, patients received BT injections around neuromas in the residual limb (peri-neuromal), subcutaneously over sensitized tissue, or as trigger point injections, plus physical and pharmacotherapy as indicated. The CMST group received injections, surgical therapies, physical and pharmacotherapies, and integrative treatments.
Main outcome measures: Mean reduction in RLP and PLP at 3-month follow-up. Secondary outcome measures were RLP and PLP and success defined as ≥30% decrease in PAP.
Results: At 3 months, the reduction in PLP scores was greater in the CMST than the BT group (2.0±2.0 vs. 3.5±3.5, p=0.002). For RLP, the reduction did not differ significantly between groups (BT 2.0±2.5 vs. CMST 3.0±2.8, p=0.50). Conversely, the reduction in PLP at 1-month favored BT (4.0±3.5 vs. 1.0±2.5, p>0.001), with no significant difference in RLP reduction. Responder rates favored BT for PLP at 1-month (68.6% vs. 43.1%, P=0.01), and CMST for RLP (97.1% vs. 63.2%, p<0.001) but not PLP at 3-months.
Conclusions: On some measures, BT outperforms or is non-inferior to CMST at 1-month but not 3-months, suggesting multimodal treatment is superior in the long-term.
目的：确定肉毒杆菌毒素（BT）注射与综合内科和外科治疗（CMST）治疗战争相关截肢后疼痛的比较效果。设计：前瞻性、比较有效性研究，评估乌克兰2家医院接受BT或CMST治疗的患者的结果。参与者：10例残肢痛（RLP）或幻肢痛（PLP）中至少2例的患者被纳入。干预措施：在BT组中，患者在残肢神经瘤周围（神经周围）注射BT，皮下过度敏感组织注射BT，或作为触发点注射，并根据指示进行物理和药物治疗。CMST组采用注射治疗、手术治疗、物理药物治疗和综合治疗。主要观察指标：随访3个月，RLP和PLP平均降低。次要结局指标为RLP和PLP，成功定义为PAP降低≥30%。结果：3个月时，CMST组PLP评分下降幅度大于BT组（2.0±2.0 vs. 3.5±3.5,p=0.002）。对于RLP，两组间差异无统计学意义（BT 2.0±2.5 vs. CMST 3.0±2.8,p=0.50）。相反，1个月时PLP降低有利于BT(4.0±3.5 vs. 1.0±2.5,p < 0.001)， RLP降低无显著差异。对PLP的应答率在1个月时倾向于BT(68.6%对43.1%，P=0.01)，而对RLP的应答率则倾向于CMST（97.1%对63.2%）。结论：在某些指标上，BT在1个月时优于CMST或不低于CMST，但在3个月时优于CMST，表明从长期来看，多模式治疗更优越。
期刊介绍：
The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities.
Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.
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