For many years Botox has been used in the treatment of a number of chronic pain conditions, including myofascial pain syndrome (MPS), neuropathic pain, chronic pelvic pain (CPP), arthritis, chronic spinal pain, headache and migraine. But how does it work and is it effective?
What is Botox?
Botulinum Toxin (or Botox) is a purified protein derived from a highly potent and infectious toxin called Clostridium Botulinum. There are many varieties of Botox, each with their own specific action. The varieties used in pain clinics have a temporary muscle-relaxing effect. By reducing muscular hyperactivity, pain is reduced.
Botox works by binding itself to the junction between the nerve and the muscle. This blocks the nerves that cause muscles to contract, thereby relaxing the muscle and reducing pain. It may take between two and four weeks following the injection before optimum relief is obtained, although some people report feeling the benefit much sooner. The effect is only temporary, usually lasting a couple of months, although in a few cases the effect lasts much longer.
Studies have suggested that in addition to its muscle-relaxing effect, Botox may also have a direct analgesic (pain-relieving) mechanism, but this has not been proven conclusively.
Is it safe?
Botox therapy for chronic pain has been used for many years and is considered to be both safe and effective. However, it should only be administered by an experienced medical professional.
Initially, before Botox is used, local anaesthetic and steroid will be injected into the area. If this is successful in reducing pain over a number of weeks, when the effect of the steroid wears off a trial of Botox may be considered. The injection(s) may be performed with the aid of x-ray guidance to ensure that the Botox is injected into exactly the right place.
Are there any side effects?
It is thought that about 5% of the Botox injected will spread around the body. This can cause some people to feel “fluey” or just “washed out” for a week or two.
Occasionally, if the injections are in the vicinity of the neck or if larger does of Botox are injected, people have reported problems with swallowing, breathing or speaking. If this occurs it is deemed a medical emergency and urgent assistance should be sought.
Do the injections have to be repeated?
As described above, the muscle-relaxing/pain relieving effect of Botox is temporary. If the initial injection(s) was beneficial and there were no serious side-effects, they can be repeated.
The hope is that once the benefit of the Botox injection kicks in, physical therapy may become possible when beforehand it could not be tolerated. This may then help to break the vicious cycle of muscle spasm and pain for longer-term benefit.
Over many years, a significant number of our clients suffering a variety of chronic pain conditions have been treated with injections of Botox. The feedback we have received has been largely, if not totally positive. Usually with the added assistance of physical therapy, a small number of those have achieved longer term benefit and overall it is certainly a therapy worthy of discussion with your pain specialist.