EP1353659A1 - Utilisation de substances neurotoxiques pour la production d'un agent servant a traiter les douleurs articulaires - Google Patents

Utilisation de substances neurotoxiques pour la production d'un agent servant a traiter les douleurs articulaires

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Publication number
EP1353659A1
EP1353659A1 EP01900365A EP01900365A EP1353659A1 EP 1353659 A1 EP1353659 A1 EP 1353659A1 EP 01900365 A EP01900365 A EP 01900365A EP 01900365 A EP01900365 A EP 01900365A EP 1353659 A1 EP1353659 A1 EP 1353659A1
Authority
EP
European Patent Office
Prior art keywords
use according
neurotoxic
concentration
joint
cresol
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP01900365A
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German (de)
English (en)
Inventor
Dominik Meyer
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Mestex AG
Original Assignee
Mestex AG
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Filing date
Publication date
Application filed by Mestex AG filed Critical Mestex AG
Publication of EP1353659A1 publication Critical patent/EP1353659A1/fr
Withdrawn legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A61K33/24—Heavy metals; Compounds thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
    • A61K31/05—Phenols
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
    • A61K31/05—Phenols
    • A61K31/055—Phenols the aromatic ring being substituted by halogen
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/075—Ethers or acetals
    • A61K31/085—Ethers or acetals having an ether linkage to aromatic ring nuclear carbon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
    • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
    • A61K31/235—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids having an aromatic ring attached to a carboxyl group
    • A61K31/24—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids having an aromatic ring attached to a carboxyl group having an amino or nitro group
    • A61K31/245—Amino benzoic acid types, e.g. procaine, novocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/275—Nitriles; Isonitriles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/28—Compounds containing heavy metals
    • A61K31/282—Platinum compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • A61K31/337—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having four-membered rings, e.g. taxol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/407—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with other heterocyclic ring systems, e.g. ketorolac, physostigmine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/475—Quinolines; Isoquinolines having an indole ring, e.g. yohimbine, reserpine, strychnine, vinblastine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P23/00—Anaesthetics
    • A61P23/02—Local anaesthetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A61P29/02—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID] without antiinflammatory effect

Definitions

  • the invention relates to the use of neurotoxic substances for the production of an agent for the treatment of joint pain according to the preamble of claim 1 and a method for applying this agent in the intracapsular space or in the joint lubrication bag of joints according to the preamble of claim 30.
  • an analgesic substance e.g. local anesthetics or morphine
  • the known method of synoviorthesis has the disadvantage of denaturing the structures, in particular the proteins, which are involved in the process of arthritis and sometimes arthrosis development also act as an inflammation trigger. This creates a fibrosis of the joint capsule which is less inflammatory and therefore less painful.
  • the fibrosis of the joint that occurs during the synoviorthesis reduces the hyperaemia that is usually present and is also to be treated, which also has therapeutic benefits.
  • the fibrotic scarring after synoviorthesis can lead to a reduced mobility of the joint, as well as to a reduced production of synovial fluid. This undesirable fibrosis of the joint capsule should be avoided and only the sensitive innervation of the joint should be switched off.
  • the invention seeks to remedy this.
  • the object of the invention is to search for suitable substances and to develop a method for injecting those substances which permanently damage the nerve endings responsible for nociception for prolonged analgesia without endangering the structures remote from the joint.
  • the invention solves the problem with the use of neurotoxic substances according to claim 1 and a method according to the features of claim 30.
  • the invention is described below for use in humans, in particular the doses indicated relate to human application. However, the invention is also suitable for the veterinary field, where adjustments in the dosage have to be made depending on the body weight of the respective animal.
  • Phenol and phenol derivatives including analogs and pharmacologically acceptable salts thereof, have proven to be particularly suitable substances for the preparation of an agent for the treatment of joint pain.
  • the cresols in particular ortho-, meta- and para-cresols and their derivatives, have proven to be effective.
  • the chloro-cresols are particularly suitable, in particular the 2-chloro-m-cresol, 3-chloro-p-cresol, 4-chloro-m-cresol, 3-chloro-o-cresol, 6-chloro-o -cresol, 2-chloro-p-cresol, 5-chloro-o-cresol, 6-chloro-m-cresol and 4-chloro-o-cresol.
  • Eugenol and thymol and their derivatives have also proven to be effective.
  • Alcohols especially ethyl alcohol, have proven to be a further preferred group of neurotoxic substances.
  • the cytostatics in particular those with neurophatic side effects, have proven to be a further preferred group of neurotoxic substances.
  • the so-called tubular and spindle poisons are particularly effective in disrupting axonal transport and reducing Waller's degeneration.
  • the taxanes have proven to be particularly efficient cytostatics, for example paclitaxel (> 200 mg / m 2 body surface), taxol (> 200 mg / m 2 body surface) and also vinca alkaloids such as: vincristine (1, 4 mg / m 2 body surface) , Vinblastine (6 mg / m 2 body surface), Vindesin (3 mg / m 2 body surface), Vinorelbine (30 mg / m 2 body surface), and finally also the marine cytostatics Aplidine, Didemnin B, Isohomohalichondrin B (IHB).
  • paclitaxel > 200 mg / m 2 body surface
  • taxol > 200 mg / m 2 body surface
  • cytostatic agents consists of alkylating substances, in particular of platinum complexes such as cisplatin (DDP) with 50-75 (up to 120) mg / m 2 body surface or 2 mg per kg body weight / week, or carboplatin (50 to 450 mgl ).
  • DDP cisplatin
  • carboplatin 50 to 450 mgl
  • the nitriles have proven to be a further preferred group of neurotoxic substances, preferably 1,3-butenenitrile (allyl cyanide) in an amount of> 20-40 mg / kg body weight; cis / trans-2-colored nitriles (crotonitriles) in an amount of> 50-100 mg / kg body weight; and 3,3'-iminodipropionitrile in an amount of 50-100 mg / kg body weight.
  • 1,3-butenenitrile allyl cyanide
  • crotonitriles crotonitriles
  • 3,3'-iminodipropionitrile in an amount of 50-100 mg / kg body weight.
  • Lidocaine preferably in a concentration of over 6%, max. Dose of 500 mg;
  • Prilocaine preferably in a concentration of over 3%, max. Dose of 600 mg;
  • Mepivacaine preferably in a concentration of over 5%, max. Dose of 500 mg; Bupivacaine, preferably in a concentration of over 1.5%, max. Dose of
  • Levobupivacaine preferably in a concentration above 5%
  • Etidocaine preferably in a concentration of over 2%, max. Dose of 300 mg;
  • Procaine preferably in a concentration of over 3%, max. Dose of 600 mg;
  • Chlorprocain preferably in a concentration of over 3%, max. Dose of 800 mg.
  • Tetracaine preferably in a concentration of over 2%, max. Dose of 100 mg.
  • the lidocaine compounds e.g. Lidocaine (8%) and its
  • Connections such as N-beta-phenylethyl lidocaine in high concentration.
  • the total amounts of local anesthetic to be used are approximately the same as the specified amounts for phenols and cresols.
  • acidic additives When using local anesthetics as a neurotoxic substance, acidic additives have been shown to have an effect-enhancing effect, for example NaHSO 3 to chloroprocaine. This lowers the pH to approximately 3, which increases the effect of the local anesthetic according to the invention.
  • the method according to the invention consists in injecting a neurotoxic, neurolytic, neuroparalytic or long-term analgesic substance (hereinafter referred to as "neurotoxic” substance in general and in particular in the claims) into a painful or diseased joint of the body in humans or animals.
  • the substance can either be left there or, after a certain exposure time, can be completely or partially sucked off again.
  • the therapeutic substance now diffuses to the sensitive nerve endings, which Directly or indirectly innervating the area of the joint, predominantly inhibits or damages it and thus leads to a reduced perception of the joint pain.
  • the joint capsule or the joint lubrication bag is used to concentrate the effect of the therapeutic substance on the location of the pain and thereby locally allow a higher concentration of the therapeutic substance than is possible without the protective joint capsule or the joint lubrication bag in the same concentration and tolerance would be possible and at the same time protect the vascular / nerve structures and other structures in the vicinity of the joint relatively.
  • long-term relief of the pain sensation emanating from the diseased ligament-capsule-joint complex is achieved by inhibiting or switching off the stimulus conduction.
  • This procedure can be used preventively or therapeutically.
  • the disinfectant effect of the neurotoxic substance kills potential infectious agents, a fact that can also be used therapeutically.
  • the procedure can be carried out with a thin, also non-arthroscopic needle.
  • the procedure does not pose a risk of infection, in contrast to the popular procedure of cortisone injection, which is highly locally promoting infection, since cortisone locally inhibits the immune system. • The procedure leads to sensitive denervation, ie the elimination of pain-guiding nerves.
  • an X-ray contrast agent e.g. a barium additive or an MRI contrast agent is used so that imaging control of the distribution of the neurotoxic substance in the intracapsular space is possible.
  • the following substances can be used as contrast agents: X-ray, CT: iodine-containing substances, e.g. triiodinated benzoates or lopamidol, ideally 30 - 80g / 100ml or z.
  • CT iodine-containing substances, e.g. triiodinated benzoates or lopamidol, ideally 30 - 80g / 100ml or z.
  • B. 5-10% of another contrast agent e.g. Barium.
  • MRI e.g. Gadolinium, e.g. per 1 ml: 469.01 mg gadopentate dimeglumide,
  • an antibiotic, disinfectant and / or sterilizing substance is added to the neurotoxic substance.
  • a viscous additive for example hyaluronic acid
  • a vasoconstrictor is used in addition to the neurotoxic substance, preferably adrenaline, noradrenaline or other similar, preferably alpha-adrenergic vasoconstrictors.
  • adrenaline the total dose of neurotoxin (ie toxic substance for the peripheral nervous system) and about a factor of 2 can be increased, since this increases the systemic
  • the adrenaline concentration can be (1: 10,000 to) 1: 80,000 to 1: 200,000.
  • the total dose of adrenaline is ⁇ 0.25 mg.
  • a 50 ml solution of 1: 200,000 adrenaline contains 0.25 mg of adrenaline.
  • an anti-inflammatory substance in addition to the neurotoxic substance, is used, e.g. non-steroidal anti-inflammatory drugs such as COX-2 inhibitors, acetylsalycylic acid, etc.
  • a steroid is used in addition to the neurotoxic substance in order to control an inflammatory reaction if this occurs. It can also be used to add a more causal treatment for painful, inflammatory joint diseases that supports symptomatic, neurolytic therapy.
  • Betamethasone has proven to be particularly suitable; e.g. 5 mg betamethasone as diproprionate (crystalline suspension) and 2 mg betamethasone as disodium phosphate (solution in 1 ml, can be added to the total amount to be injected). This solution is equivalent to 45/23 mg prednisone / prednisolone.
  • glycerol is used as a solvent in addition to the neurotoxic substance.
  • Glycerin also has neurotoxic properties (especially when it is injected intraneurally).
  • Glycerin also has a lubricating ability for the joint, so that a physical effect also occurs.
  • the concentration of glycerin is preferably between 10 and 95%.
  • an analgesic is used in addition to the neurotoxic substance in order to induce short-term analgesia cause in the event that the neurolytic effect is delayed and a painful period occurs first.
  • Highly concentrated, but normally dosed local anesthetics, for example the substances listed above, have proven to be particularly efficient.
  • glycerin as a solvent is that it is hyperbaric and in itself somewhat neurotoxic.
  • Some substances have been shown to have an effect-enhancing effect on the neurotoxic substances, for example antioxidants, preservatives and excipients, in particular sodium bisulfite (> 0.2%), NaHSO 3 , ammonium compounds, such as ammonium sulfate (NH) 2 SO , 2 - 10 (- 30%), polysorbate 80 (PS80) 0.025 mg / ml.
  • the neurotoxic substance is preferably dissolved in a solvent which is compatible with the body and is expediently injected in a volume which corresponds to the available space in the joint to be treated, so that it becomes bulky.
  • the advantage of an optimal distribution of the neurolytic substance is thus achieved.
  • the volume of liquid to be injected into the intracapsular area can be from 0.1 to 150 ml. For a finger joint, about max. 1ml, for the shoulder joint max. 10 ml, for the knee joint about 30 - 50 ml.
  • the dosage of the neurolytic substance depends on its absolute solubility in the chosen solution medium.
  • the capsule thickness of the affected joint has a significant influence on the dosage. The thicker the capsule, the more neurolytic substance is necessary.
  • the therapist After an optional, immediate or longer previous diagnostic injection of local anesthetics, the therapist inserted a syringe needle under the optional, simultaneous (image converter, CT, sonography, MRI, etc.) or subsequent (X-ray, CT, MRI, sonography, etc.) imaging control Joint space of a knee joint and injected 40 ml of a solution of m-chloro-cresol in glycerin into the intracapsular space. The patient felt significant relief from his symptoms just 14 hours after the procedure. This lasted for over 6 months.
  • the injected solution corresponded to that of Example 1, with the difference that for the imaging method to be used, 5 ml of a visible contrast medium (lopamidol in a concentration of 50 g / 100 ml) was added, which spread within the joint capsule after the injection and thus the The location of the injection needle and the distribution of the therapeutic substance within the capsule were documented.
  • the neurotoxic substance contained in the injected solution was aspirated again immediately after the injection. However, it can also be drawn off after a defined substance-dependent exposure time or not at all. The patient felt significant relief from his symptoms as early as 15 hours after the procedure. This lasted for over 8 months.
  • the therapist inserted a thin infusion catheter analogous to an epidural catheter into the affected joint and injected with a perfusor the neurotoxic substance, which in this case was low in concentration (2-5% chlorocresol, 5% hydrocortisone (optional), 80-95% glycerin, 0- 10% contrast agent) in the affected joint at a rate of 1- 10 ml / h for 12 h.
  • a drain catheter with an optionally defined drain resistance (eg 20 mm Hg) in order to achieve a fluid turnover.
  • the therapist After implantation of an artificial joint (e.g. knee), the therapist injected 50 ml of the neurotoxic substance into the resealed joint capsule (in another embodiment: in the periprosthetic area without a capsule). This minimized postoperative pain.
  • the neurotoxic substance was also concentrated in this case (5% chlorcresol in glycerol as solvent) to enable later re-innervation.
  • the neurotoxic substance (here highly concentrated: 5% chorosol in glycerol) could be injected into the (Neo) capsule around the prosthesis, which led to the patient having a permanent (over a year ) Pain relief was experienced within a few (6-12) hours.
  • the infection around the prosthesis was largely contained and, in some cases, even completely eliminated by diffusion of the neurotoxic substance (which also had an antiseptic effect) along the prosthesis socket and around the socket.
  • This treatment can optionally be supported with systemically administered antibiotics (e.g. with rifampicin 450 mg, ciprofloxacin 750 mg).
  • the neurotoxic substance was injected into the joint. Again, the distribution of the substance could be checked by imaging with the addition of the appropriate contrast agents. An anti-inflammatory substance was optionally added A few minutes after the injection, the pain persisted permanently, so that the patient with physiotherapy regained the mobility lost due to the capsulitis.With this application, only a temporary analgesia (2-3 weeks) is sometimes desired, which is why the concentration of the neurotoxic substance is here was kept rather low (2-3% chlorocresol).
  • the therapist injected 5 ml of a neurotoxic substance consisting of 8% phenol and 5% cortisone in glycerol as a solvent into a chronically inflamed bursa trochanterica (trochanter major) of the hip.
  • the therapist injected 1 ml of a neurotoxic substance consisting of 15% lidocaine, adrenaline (1: 80000) and 5% contrast medium in physiological saline as a solvent into a painful, arthrotic finger joint. After about 15 minutes, the patient's symptoms disappeared for several months. The correct position of the injection needle could be documented using the contrast medium.
  • the therapist injected a mixture of 5% chlorocresol, 10% lidocaine and vinkristine in an amount of 0.7 mg / m 2 body surface in glycerol as a solvent.
  • This mixture was particularly effective because its components injure the nerves to be damaged in different ways.
  • the effect of chlorocresol is that it dissolves the nerve membrane, that of lidocaine, that it nerves via irreversible receptor blocking, as well as toxic intracellular Ca release and destroyed that of Vinkristin that it was the
  • Nerve regeneration is permanently prevented and axonal transport inhibited.
  • the mixture additionally contained adrenaline 1: 80000 and 10%

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  • Health & Medical Sciences (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
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  • Life Sciences & Earth Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Epidemiology (AREA)
  • General Chemical & Material Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Organic Chemistry (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Engineering & Computer Science (AREA)
  • Pain & Pain Management (AREA)
  • Inorganic Chemistry (AREA)
  • Emergency Medicine (AREA)
  • Rheumatology (AREA)
  • Neurology (AREA)
  • Biomedical Technology (AREA)
  • Neurosurgery (AREA)
  • Anesthesiology (AREA)
  • Immunology (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
  • Medicinal Preparation (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • Medicines Containing Antibodies Or Antigens For Use As Internal Diagnostic Agents (AREA)

Abstract

L'invention concerne l'utilisation de substances neurotoxiques, qui sont notamment toxiques pour l'axone et les terminaisons nerveuses nociceptives, pour la production d'un agent servant à traiter les douleurs articulaires.
EP01900365A 2001-01-24 2001-01-24 Utilisation de substances neurotoxiques pour la production d'un agent servant a traiter les douleurs articulaires Withdrawn EP1353659A1 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/CH2001/000053 WO2002058688A1 (fr) 2001-01-24 2001-01-24 Utilisation de substances neurotoxiques pour la production d'un agent servant a traiter les douleurs articulaires

Publications (1)

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EP1353659A1 true EP1353659A1 (fr) 2003-10-22

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EP01900365A Withdrawn EP1353659A1 (fr) 2001-01-24 2001-01-24 Utilisation de substances neurotoxiques pour la production d'un agent servant a traiter les douleurs articulaires

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US (1) US20040047807A1 (fr)
EP (1) EP1353659A1 (fr)
JP (1) JP2004521112A (fr)
CA (1) CA2435418A1 (fr)
WO (1) WO2002058688A1 (fr)

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CA2435418A1 (fr) 2002-08-01
JP2004521112A (ja) 2004-07-15
US20040047807A1 (en) 2004-03-11

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