The use of Botulinum Toxin or Botox in the treatment of chronic pain has become relatively common. In fact, it was first utilised as a muscle relaxant in the treatment of pain long before its cosmetic use became widespread.
Botox works by blocking the neurotransmitters that tell muscles to contract – no contraction / no pain – that’s the theory. Unlike muscle relaxing drugs taken orally, it can be relatively long lasting and doesn’t have the sedative effect which is a common side effect of the oral medication.
The use of Botox has become particularly common in the treatment of Myofascial Pain Syndrome (MPS). MPS is a pain syndrome characterised by trigger points, which are highly sensitive areas located in taut bands of skeletal muscle. Touching these trigger points can not only cause extreme localised pain, but also referred pain in other areas of the body. Injecting these sites with Botox can produce prolonged muscle relaxation and therefore pain relief.
One of our clients who underwent Botox injections for MPS described her experience as follows: “The injections weren’t actually as painful as I’d expected. They took a few days to really work but the Botox was the first long-lasting relief I’d had since the MPS came on. It’s been a couple of months now and I know the injections are likely to start wearing off soon, but I’m due to see my pain consultant again as I’d like to renew them.”
However, side effects are quite common. Symptoms including bruising, flu-like symptoms, headaches, abdominal pain and muscle weakness (where it’s not wanted!) are commonly reported. It is also clear that the body can become immune to the effects of Botox.
The efficacy of Botox in the treatment of chronic pain has been the subject of many clinical trials. Overall, these trials suggest that Botox generally has a positive effect upon levels of pain. However, it has to be said that the results of the clinical trials are in many respects extremely contradictory, particularly when considering the areas of the body where pain is experienced. For example, the benefits of Botox reported where the MPS is associated with neck and back pain seem particularly contradictory, whereas for Piriformis Syndrome (myofascial pain in the buttock) results generally seem to be excellent.
Many of these trials have been relatively small scale and the methodology of others has been criticised. There also seems little available date on the long term effects of multiple uses of Botox as a treatment for chronic pain.
Despite the volume of research data already available, it is clear that more large scale, longer term research is required before a definitive view can be given.
For now, a careful discussion with your pain specialist is essential when considering whether it may be appropriate to consider Botox as a treatment for your chronic pain.
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