Derived from the bacterium Clostridium Botulinum, Botox belongs to a group of drugs commonly known as Botulinum Toxin. There are seven different type of Botulinum toxin and the Type A is used most commonly in the clinical setting. Towards the middle of the last century, the muscle-relaxant properties of Botulinum Toxin Type A were first identified, and subsequently intensive research over the years have significantly indicated the positive role that this category of toxin can play to relieve pain from muscle spasm and improve range of motion (ROM). Nearly 1 million muscle pain patients worldwide have reportedly benefited from the Botulinum Toxin Type A formulations.
Botox injections are now typically indicated for:
Muscle pain arising from chronic muscle spasm
Neck pain in cervical dystonia in adults
Migraine Headaches
Nerve disorders in blepharospasm
Myofascial pain
Botox works by blocking the release of a substance called acetylcholine from the junction between a nerve and muscle. The binding of acetylcholine to its receptor at this junction results in muscle contraction. When too much acetylcholine is secreted, the muscular activity is heightened leading to fatigue and resulting in pains and spasms. When acetylcholine release is blocked, the muscles can relax, and diminish pain and fatigue syndromes.
Botox is administered directly to the desired site of action through injection. The onset of relief occurs in about a week and lasts, typically, for about 3 months. After three months, the muscles once again resume becoming overactive through excessive release of acetylcholine. Physical Therapy during this period of time can help maintain flexibility and diminish recurrence of spasms). Normally, four injections per year are considered sufficient and long-term therapies with Botox injections have been found to be consistently effective.
The efficacy of Botox injections in treating migraines has been extensively studied and it has largely been found that patients with chronic headaches and migraines that occur on 16 or more days each month report at least 50% decrease in headache days, decrease in headache episodes per day, and decrease of use of medication.
Botox injections have also been found to very effective as adjuncts to physical therapies in treating muscular spasms. The botox injection relaxes the sore muscle and prepares ground for the physical therapist to apply the restorative procedures to relieve muscle spasms.
Other than some swelling, tenderness and localized pain at the site of the injection, reactions to Botox injections for treatment of muscular pain have seldom been reported. However, in patients receiving the injections for treatment of cervical dystonia and blepharospasm, occasional incidences of difficulty in swallowing, upper respiratory tract infections, headache, neck pain in the former and droopy eyelids, inflammation of the cornea and dryness of the eyes in the later have been reported.
Resources and references:
1. A randomized trial of 31 adults for the evaluation of Botox Injection for pain management. Foster L, et al. (2001) Neurology, 56(10): 1290-1293
2. Barrientos and Mausktop 2002.
3. Botulinum toxin injection to facilitate rehabilitation of muscle imbalance syndromes in sports medicine by Cullen DM, Boyle JJ, Silbert PL, Singer BJ and Singer KP at Excel Sports Group, Osborne Park, Western Australia, Australia in Disabi.l Rehabil. 2007 Dec 15; 29 (23): 1832-9
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