by Point Performance’s Mark Klaiman, MD
Botulinum toxin A, widely known as Botox, has been used by physicians for many years to treat a wide range of medical conditions. Perhaps best known for its cosmetic applications, botulinum toxin is also regarded as a cornerstone therapy for a host of neurological and pain related disorders. It has demonstrated effectiveness in the management of chronic migraine headaches, chronic muscular neck and lower back pain, in addition to the pain associated with various neurological disorders resulting in uncontrolled muscle spasticity. This is often seen as a complication of stroke, spinal cord injury, head injury, Parkinson’s disease and cervical dystonia.
What is botulinum toxin (Botox)?
Botulinum toxin is a neurotoxin, isolated from Clostridium botulinum, a bacterium that occurs naturally in the environment including the intestinal tracts of mammals and fish. In these settings the bacteria is harmless however, under certain circumstances, the bacteria can proliferate and cause botulism, a potentially deadly illness in which the neurotoxin attacks the body’s nerves, resulting in muscle paralysis.
How does botulinum toxin (Botox) work?
While botulinum toxin can be deadly in high concentrations, it has been shown to have very successful and wide reaching therapeutic applications when used in extremely small amounts.
Muscular contraction requires an intimate communication between the nerves and muscles that they supply. This activity is dependent on the release of a chemical messenger, called acetylcholine, at the junction between the nerve and muscle. When injected into a target muscle, botulinum toxin prevents the release of acetylcholine, thereby reducing muscle contraction, resulting in muscle relaxation and decreased stiffness. This can have desired effects in situations where muscles are uncontrollably tight or in spasm.
What does botulinum toxin (Botox) treat and how can it reduce pain?
While botulinum toxin is best known for its cosmetic applications, particularly in the treatment of facial wrinkles, there are at least 20 additional medical conditions that have benefitted from therapy. These represent both approved and off label indications. Botox has been approved to treat post-stroke upper extremity spasticity, chronic migraine, and severe neck pain and spasms associated with cervical dystonia. Cervical dystonia is a painful condition in which the neck muscles involuntarily contract and twist the neck in an abnormal position. Similar conditions of involuntary muscle spasms associated with head injury, spinal cord injury, cerebral palsy, and Parkinson’s disease, have been successfully treated for many years, although these are considered off-label conditions. Additionally, there are various reports of successful therapy with botulinum toxin in the treatment of chronic muscular or myofascial neck, lower back and buttock pain.
How is botulinum toxin administered?
Botulinum toxin A is sold commercially under various names including Botox, Dysport, Xeomin, and Myobloc. It comes in a powder which requires dilution into a clear liquid before injection.
Patients who have unsuccessfully tried other avenues for muscle spasm and pain treatment may opt for botulinum toxin as a way to relieve their chronic symptoms. The treating physician will first clinically evaluate someone and identify the involved muscles causing the pain and spasm. The most common way to identify the muscles is with an electrical technique called electromyography. Ultrasound has become an increasingly popular tool as well. Accuracy is important, since the likelihood of success is dependent on getting the medication directly into the desired muscle.
The procedure does not require anesthesia, is generally very well tolerated, and the beneficial effects are often seen within 3-5 days. Unfortunately, the toxin wears off between 3-6 months but injections can be repeated every few months. The pain relief associated with migraine and cervical dystonia can be so dramatic that patients will return with incredible consistency as the medication wears off and their symptoms return. In addition to pain reduction patients will frequently report increased joint range of motion, improved sleep and overall benefits in quality of life.
What are the risks and side effects of botulinum toxin?
Botulinum toxin is a remarkably well-tolerated and very safe drug. The main side effect that people experience is temporary weakness in the muscle that’s being injected. The amount of weakness is directly related to the amount of Botox injected. The smaller the muscle is, the more likely you are to potentially notice weakness. Other side effects are uncommon, often associated with the area being injected, and may include mild post-injection pain, headache, flu-like symptoms, rash, dry mouth, blurred vision, difficulty swallowing, and cough.
If you think you might be a good candidate for Botox, contact Point Performance for an evaluation.