Our article on the use of Botulinum Toxin or Botox in the treatment of chronic pain focused on its use in the treatment of Myofascial Pain Syndrome (MPS). In the short time since publishing that article, we have been contacted a number of readers who highlight its use in the treatment of Complex Regional Pain Syndrome (CRPS).
The benefit of Botox in the treatment of MPS is gained as a result of the relaxing effect that it has on skeletal muscles. However, Botox also seems to have an anti-nociceptive action; in other words it can block the detection of pain stimuli.
Whilst there is little in the way of published clinical research, in 2011, researchers at the Drexel University College of Medicine published a paper with the objective of assessing “whether intramuscular botulinum toxin injections cause relief of pain caused by CRPS, and to assess the risks of this treatment.”
This was not a clinical trial but a retrospective review of clinical records of “thirty-seven patients with spasm/dystonia in the neck and/or upper limb girdle muscles.” However, the results of that limited study seemed encouraging, with 97% of that small group having significant pain relief. The mean pain score was reduced by 43%.
The conclusion was that “Intramuscular injection of botulinum toxin in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS. The incidence of complications was low (2.7%).”
However, one lady who has contacted us is keen to share her negative experience of Botox. She says “I have had RSD for a number of years now. The muscles in my left shoulder and across my back have been very tight and the muscle spasms were excruciating. I had tried trigger point injections which were fine with some relief until they wore off. My pain doctor suggested I have a think about Botox but I was reluctant because I couldn’t find much information. I did eventually agree but have regretted it ever since. My pain is now through the ceiling and I just pray that it starts to settle down when the Botox wears off.”
This is clearly an entirely different experience to that reported by most patients in the 2011 paper. Of course, there could be other factors at play such as needle size or the temperature of the drug at the time it was administered, but one would have thought this was unlikely given that the drug is being administered by a pain professional who is presumably acutely aware of the various protocols.
There is clearly a very strong case here for a large scale clinical trial.