Palabras clave
dolor crónico
trastornos migrañosos
Cómo citar
Resumen
La toxina botulínica de tipo A (BTX-A) es un agente terapéutico eficaz y seguro para el manejo del dolor crónico, según esta revisión sistemática que sintetiza evidencia de 2018 a 2025. La revisión incluyó 37 estudios (N=3.247) de calidad metodológica moderada a alta. La BTX-A ofrece una reducción clínicamente significativa del dolor (≥50%) con una duración del efecto de 12 a 24 semanas. Su mecanismo de acción es bifásico: además de la inhibición de acetilcolina, bloquea la liberación de neurotransmisores nociceptivos (Sustancia P, CGRP, glutamato). Las indicaciones con evidencia de nivel A son la migraña crónica (reducción en EVA de 8.4→4.2) y la distonía cervical. Se reportaron resultados alentadores en el dolor oncológico refractario (reducción de EVA de 8.2→4.1, con 35% de disminución en el uso de opioides) y en el dolor neuropático focal. El perfil de seguridad es altamente favorable, con una incidencia global de efectos adversos baja (≈0.8%). Los eventos más comunes son la debilidad muscular localizada (2.3%) y la cefalea postinyección, todos autolimitados. Las técnicas de inyección guiadas por ultrasonido han mejorado la precisión y seguridad del procedimiento. La BTX-A se establece como una herramienta valiosa en el marco multidisciplinario del dolor.
Referencias
(1) Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, Lipton RB, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT program. Headache. 2010;50(6):921-36. Disponible en: https://doi.org/10.1111/j.1526-4610.2010.01678.x
(2) Aurora SK, Dodick DW, Turkel CC, DeGryse RE, Silberstein SD, Lipton RB, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the randomized, placebo-controlled phase of PREEMPT 1. Cephalalgia. 2010;30(7):793-803. Disponible en: https://doi.org/10.1177/0333102410364676
(3) Herd CP, Tomlinson CL, Rick C, Scotton WJ, Edwards J, Ives NJ, et al. Botulinum toxins for the prevention of migraine in adults: Cochrane systematic review and meta-analysis. BMJ Open. 2019;9:e027953. Disponible en: https://doi.org/10.1136/bmjopen-2018-027953
(4) Lanteri-Minet M, Ducros A, Francois C, Olewinska E, Nikodem M, Dupont-Benjamin L. Effectiveness of onabotulinumtoxinA (BOTOX®) for the preventive treatment of chronic migraine: a meta-analysis on 10 years of real-world data. Cephalalgia. 2022;42(14):1543-64. Disponible en: https://doi.org/10.1177/03331024221123058
(5) Attal N, de Andrade DC, Adam F, Ranoux D, Teixeira MJ, Galhardoni R, et al. Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2016;15(6):555-65. Disponible en: https://doi.org/10.1016/S1474-4422(16)00017-X
(6) Egeo G, Moreau N, Guaschino E, Sarchielli P, Antonini G, Di Stefano G, et al. Botulinum neurotoxin for the treatment of neuropathic pain: a critical update. Front Neurol. 2020;11:716. Disponible en: https://doi.org/10.3389/fneur.2020.00716
(7) Wei J, Zhu X, Yang G, Shen J, Xie P, Zuo X, et al. The efficacy and safety of botulinum toxin type A in treatment of trigeminal neuralgia and peripheral neuropathic pain: a meta-analysis of randomized controlled trials. Brain Behav. 2019;9(10):e01409. Disponible en: https://doi.org/10.1002/brb3.1409
(8) Dhanasekara CS, Payberah D, Chyu JY, Shen CL, Kahathuduwa CN. The effectiveness of botulinum toxin for chronic tension-type headache prophylaxis: a systematic review and meta-analysis. Cephalalgia. 2023;43(3):3331024221150231. Disponible en: https://doi.org/10.1177/03331024221150231
(9) De la Torre Canales G, Poluha RL, Bonjardim LR, Ernberg M, Conti PCR. Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain: a randomized double-blind clinical trial. Sci Rep. 2024;14(1):4201. https://doi.org/10.1038/s41598-024-54906-z
(10) Kim SR, Chang M, Kim AH, Kim ST. Effect of botulinum toxin on masticatory muscle pain in TMD: randomized, double-blind, placebo-controlled pilot. Toxins. 2023;15(10):597. Disponible en: https://doi.org/10.3390/toxins15100597
(11) Delcanho R, Val M, Guarda Nardini L, Manfredini D. Botulinum toxin for treating temporomandibular disorders: what is the evidence? J Oral Facial Pain Headache. 2022;36(1):6-20. Disponible en: https://doi.org/10.11607/ofph.3023
(12) Kępczyńska K, Domitrz I. Botulinum toxin-A current place in the treatment of chronic migraine and other primary headaches. Toxins (Basel). 2022;14(9):619. Disponible en: https://doi.org/10.3390/toxins14090619
(13) Bianchi F, Nelson M, Wissel J, Kim H, Traut A, Shah D, et al. OnabotulinumtoxinA in the management of pain in adult patients with spasticity: a systematic literature review. Toxins (Basel). 2025;17(8):418. Disponible en: https://doi.org/10.3390/toxins17080418
(14) Lippi L, Mattiuzzi C, Sanchis-Gomar F, Henry BM. Botulinum toxin for pain relief in cancer patients: systematic review of RCTs. Support Care Cancer. 2024;32(6):264. Disponible en: https://doi.org/10.1007/s00520-024-08265-1
(15) Hernández-Rodríguez D, Guillén-Núñez MR, Juárez-Lemus AM, Plancarte-Sánchez R, Aguilera-Elizalde BB, González-Vega OH. Effectiveness of botulinum toxin for oncologic pain. J Drug Deliv Ther. 2024;14(2):7-13. Disponible en: https://jddtonline.info/index.php/jddt/article/view/6414
(16) Sole-Cruz E, Van Obberghen-Blanc E, Hirtz C, Bennour I, Lanteri-Minet M, Donnet A. Real-world evaluation of botulinum toxin A in focal peripheral neuropathic pain: longitudinal outcomes. Eur J Neurol. 2025;32(9):e70362. Disponible en: https://doi.org/10.1111/ene.70362
(17) Gharaei H, Gholampoor N. Optimizing pain relief in refractory thoracic outlet syndrome: the role of ultrasound-guided injections. Pain Physician. 2025;28(5):E509-23. Disponible en: https://pubmed.ncbi.nlm.nih.gov/40986903/
(18) Espandar R, Heidari P, Rasouli MR, Saadat S, Farzan M, Rostami M, et al. Use of anatomic measurement to guide injection of botulinum toxin for the management of chronic lateral epicondylitis: a randomized controlled trial. CMAJ. 2010;182(8):768-73. Disponible en: https://doi.org/10.1503/cmaj.090906
(19) Wong SM, Hui AC, Tong PY, Poon WF, Yu E, Wong LK, et al. Treatment of lateral epicondylitis with botulinum toxin A: randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2005;143(11):793-7. Disponible en: https://doi.org/10.7326/0003-4819-143-11-200512060-00007
(20) Placzek R, Drescher W, Deuretzbacher G, Hempfing A, Meiss AL. Treatment of chronic radial epicondylitis with botulinum toxin A. J Bone Joint Surg Am. 2007;89(2):255-60. Disponible en: https://doi.org/10.2106/JBJS.F.00401
(21) Su YC, Chen WS, Wang JL, Chang CY. Effectiveness of different doses of botulinum neurotoxin in lateral epicondylitis: systematic review. Clin Neurol Neurosurg. 2023;226:107581. Disponible en: https://doi.org/10.1016/j.rehab.2022.101711
(22) Tan HL, Yakkaphan P, Beke A, Renton T. Onabotulinum toxin A treatment for posttraumatic trigeminal neuropathic pain: case series and literature review. J Oral Facial Pain Headache. 2024;38(1):93-105. Disponible en: https://doi.org/10.22514/jofph.2024.009 [Retractado: J Oral Facial Pain Headache. 2025;39(2):210. https://doi.org/10.22514/jofph.2025.040]
(23) Ramos-Herrada RM, Arriola-Guillén LE, Atoche-Socola KJ, Bellini-Pereira SA, Castillo AA. Effects of botulinum toxin in patients with myofascial pain related to temporomandibular joint disorders: a systematic review. Dent Med Probl. 2022;59(2):271-80. Disponible en: https://doi.org/10.17219/dmp/145759
(24) Crisafulli S, Ciccimarra F, Khan Z, Maccarrone F, Trifirò G. Understanding clinical effectiveness and safety implications of botulinum toxin in children: a narrative review of the literature. Toxins (Basel). 2024;16(7):306. Disponible en: https://doi.org/10.3390/toxins16070306
(25) Carpentier VT, Weiss N, Salem JE, Joussain C, Levy J, Mariani LL, et al. Real-life prognosis of neurological complications of botulinum toxin: a nationwide pharmacovigilance study of adverse drug reactions reported in France between 1994 and 2020. Ann Phys Rehabil Med. 2025;68(3):101924. Disponible en: https://doi.org/10.1016/j.rehab.2024.101924
(26) Uppsala Monitoring Centre (UMC). About VigiBase (WHO global database of adverse event reports) [Internet]. Uppsala: UMC; 2025 [citado 15 Oct 2025]. Disponible en: https://who-umc.org/vigibase-data-access/about-vigibase/
(27) Centers for Disease Control and Prevention (CDC). Health Alert Network (HAN 00507): adverse effects linked to counterfeit or mishandled "Botox" [Internet]. Atlanta: CDC; 23 Apr 2024 [citado 15 Oct 2025]. Disponible en: https://www.cdc.gov/han/2024/han00507.html
(28) New York City Department of Health and Mental Hygiene (NYC DOHMH). Advisory: adverse effects linked to counterfeit botulinum toxin injections [Internet]. Nueva York: NYC DOHMH; 23 Apr 2024 [citado 15 Oct 2025]. Disponible en: https://www.nyc.gov/assets/doh/downloads/pdf/han/advisory/2024/han-advisory-11.pdf
(29) Shilova O, Shramova E, Proshkina G, Deyev S. Natural and designed toxins for precise therapy: modern approaches in experimental oncology. Int J Mol Sci. 2021;22(9):4975. Disponible en: https://doi.org/10.3390/ijms22094975
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Derechos de autor 2026 Carlos Miguel Ríos-González