In cervical dystonia, pain is the other half of the story
Patients with cervical dystonia have an abnormal positioning of the head and neck, and many patients have an impaired ability to perform daily functions.20 However, these signature effects of cervical dystonia tell only part of the story. Neck pain is another primary symptom of cervical dystonia, reported in 75% of patients.21 Of those patients who reported pain, nearly 7 out of 10 say it is moderate or severe. 22
According to a literature review article by Chan et al, this “remarkably high incidence of pain” makes cervical dystonia distinct among focal dystonias and contributes to disability.22 The review by Chan et al compared patients with cervical dystonia who had no pain to those with painful cervical dystonia. The authors found that patients with painful cervical dystonia had significantly lower (worse) disability scores. 22
Cervical dystonia also has a dramatic impact on quality of life (QOL), as reported by Camfield et al. 20 The authors evaluated QOL in a cohort of 289 patients using a generic health status measurement scale (SF-36). Results showed that cervical dystonia had a significantly negative impact on QOL when compared with the general population. In fact, patients with cervical dystonia scored much worse in all 8 physical and mental domains on the SF-36. Additionally, when patients with cervical dystonia were compared with patients with other neurological conditions (eg, Parkinson’s disease [PD], stroke), QOL scores were similarly low for select domains. For energy/vitality, patients with cervical dystonia had scores comparable to those of stroke patients; cervical dystonia pain scored similar to PD pain; and for physical role limitation, patients with cervical dystonia scored significantly lower than both groups, despite having higher physical function scores. According to the authors, “One possible explanation is that pain limits such activities.”20
Despite these challenges, clinical success in treating cervical dystonia and its associated neck pain is possible. Neurologists, physiatrists, pain specialists, and anesthesiologists have found botulinum toxins to be an effective first-line treatment of cervical dystonia. Within this class, there is only one type B product marketed in the US— MYOBLOC, and it offers a range of supporting data in treating painful cervical dystonia.
Clinical studies for MYOBLOC
For additional information regarding cervical dystonia, please visit the NIH Web site at www.ninds.nih.gov/disorders/dystonias/dystonias.htm.
Assessing cervical dystonia and associated neck pain
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