Botox Injections for Pain Relief
Botulinum toxin, prescribed as the brand Botox, is a purified neurotoxin derived from the bacterium Clostridium botulinum. The bacterium is the most poisonous biological organism known, and consuming even a tiny amount causes fatal paralysis of organ systems. This paralyzing quality can be beneficial for certain medicinal and cosmetic purposes when administered appropriately. The U.S. Food and Drug Administration has approved Botox to smooth frown lines and to treat excessive sweating (hyperhidrosis), eyelid twitching, crossed eyes and certain types of muscle spasms. Although Botox is not approved to treat general muscle or headache pain, it is sometimes prescribed for these purposes.
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Cervical Dystonia
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An early approved use for Botox was treating the severe muscle spasms caused by cervical dystonia, also called spasmodic torticollis. Cervical dystonia is a chronic neurological movement disorder which causes the patient's neck to repeatedly turn involuntarily. The spasms often are painful. Because Botox temporarily weakens or paralyzes muscles, it was found effective at treating this disorder. Botox blocks the nerve signal from reaching the muscle, preventing the muscle spasm. The injection effects usually last between two to three months.
Back Pain
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Botox is not approved to treat muscle spasms other than those caused by cervical dystonia, but doctors have found it effective at treating chronic back pain caused by muscle spasms. For instance, a study published in a 2003 issue of the The Internet Journal of Pain, Symptom Control and Palliative Care found that patients with chronic low back pain, some due to muscle spasms, showed improvement in range of motion and pain scores when injected with Botox, compared to patients not treated.
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Osteoarthritis
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Injecting Botox directly into the knee and shoulder joints of patients with osteoarthritis has been found effective at decreasing severe pain, according to research conducted by the Minneapolis Veterans Administration Medical Center and presented at the 2006 and 2007 annual meetings of the American College of Rheumatology. Patients receiving Botox injections experienced significant reductions in pain compared with patients receiving a placebo. Botox injections had little effect on people with moderate pain, however.
Migraines
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Some doctors also prescribe Botox injections to prevent migraine headaches. Two 2008 studies by manufacturer Allergan found that patients injected with Botox had fewer headaches, with a reduction of 7.8 and nine fewer days each month, compared with a drop of 6.4 and 6.7 days in the placebo groups. A press release from Allergan called the results significant, but at least one insurance company, Regence BlueShield, is suspending coverage for this use, stating that at least three studies published since 2004 have indicated that Botox is not significantly effective at preventing migraines.
Considerations
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Botox can cause temporary weakness in nearby muscles. When used for cervical dystonia, it may cause difficulty swallowing. Muscle weakness was not seen in the studies involving osteoarthritis, likely because Botox was injected into a joint and not a muscle. People can develop a resistance to Botox because the body produces antibodies against the toxin, eventually making it ineffective. Additionally, Botox is pricey, about $650 every three months for the drug alone as of 2009, according to the Seattle Times. Many insurance policies do not cover treatments not approved by the FDA.
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