OnabotulinumtoxinA, better known as Botox, is a neurotoxin used as a medical intervention in a few different conditions due to its ability to temporarily prevent muscles from activating, reducing certain types of muscle- and nerve-related pain. In addition to being used in the treatment of certain kinds of pain, Botox is also injected cosmetically to reduce wrinkles and can be prescribed in the treatment of hyperhidrosis (excessive sweating) and other autonomous nerve conditions.
Botox injections are not necessarily harmless, but as with everything else, it’s the dosage that makes the poison. When applied by a specialist under strict supervision, a single Botox injection can have few to no adverse effects while reducing nerve and spasm-related pain.
Since the earliest medical uses of onabotulinumtoxinA back in the 1970s, other botulinum products have hit the market, including incobotulinumtoxinA, abobotulinumtoxinA, and rimabotulinumtoxinB.
While these drugs aren’t interchangeable, it should be noted that the botulinum toxin used for cosmetic purposes is virtually identical to the toxins used for medical purposes – all that changes are the injection site and dosages used.
Why Botox?
Botox as a medical product has only a short history of a few decades, but the bacterial toxin causing botulism has been around for thousands and thousands of years.
First discovered and identified as a disease in 19th century Germany and named by Belgian professor Emile Pierre van Ermengem, botulism is caused by a high dosage of the botulinum toxins produced by the bacteria Clostridium botulinum, first associated with sausages (hence the name, from the Latin botulus). Botulism is fatal, inhibiting the release of acetylcholine, a chemical that plays a vital role in the communication between nerves, causing paralysis that ends in death.
The botulinum toxin first became a viable medical treatment when scientists began utilizing it to treat cross-eyed patients (strabismus), after decades spent trying to isolate the toxin in crystalline form.
During animal testing, researchers discovered that the toxin also happened to reduce forehead and brow ridge wrinkles in monkeys, planting the seeds for Botox’ extensive history as a cosmetic procedure as well as a neuropathic treatment.
How Does Botox Affect Pain?
Botox can reduce pain under certain circumstances by altering the way nerves communicate through the blocking of acetylcholine.
Depending on the condition, this ability also helps Botox treat things like incontinence or excessive sweating caused by malfunctioning nerves, as well as chronic migraine. Botox has also seen limited success in the treatment of myofascial pain and certain kinds of nerve pain, including temporomandibular disorders. A common use for Botox is in the treatment of a particularly painful stiff neck, or cervical dystonia.
What Other Conditions can Botox Injections Help With?
Since the 70s, Botox and other forms of botulinum toxin have been successfully approved by the FDA as a treatment for:
- Strabismus
- Blepharospasm (involuntary eyelid twitching)
- Cervical dystonia (involuntary neck contractions)
- Glabellar lines (wrinkles between the eyebrows)
- Axillary hyperhidrosis (excessive sweating)
- Chronic migraine
- Upper lip spasticity
- Urinary incontinence
- Crow’s feet
Off label uses of Botox include:
- Temporomandibular joint disorder (a leading cause of jaw grinding and pain)
- Acne
- Other muscle spasticity disorders
- Myofascial pain syndromes
- Certain cases of nerve pain
What Are the Side Effects of Botox Injections for Pain?
As a neurotoxin, Botox does have its fair share of potential side effects and important contraindications.
The risks of a Botox injection can include:
- Temporary facial paralysis, crooked smile, drooling.
- Eye dryness or excessive tearing.
- Headaches.
- Pain at the injection site (swelling, bruising)
If any of the following symptoms are occurring after a Botox injection, the toxin may have spread to other parts of the body. Call your doctor right away if you are experiencing:
- Loss of bladder control
- Trouble swallowing
- Difficulties speaking
- Trouble breathing
- Sudden weakness
- Blurry vision
Contraindications for Botox Injections
Contraindications are reasons not to take a certain medication or drug. In the case of a Botox injection, your doctor won’t recommend it if you have a history of:
- Botulism
- ALS
- Peripheral motor neuropathy
- Myasthenia gravis
- Double or blurred vision
- Progressive muscle weakness from cancer
- Decreased lung function
- Pneumonia
- And a few others
Be sure to go over your medical history with a pain specialist before considering a Botox injection for pain or cosmetic purposes.
At the end of the day, Botox is still a safe and well-tolerated medical intervention when identified as an appropriate treatment method. Botulism is exceedingly rare in modern times, let alone as a result of medical treatment, and the side effects of Botox can be managed given they’re caught and attended to early on. Be sure to talk to your doctor about any other concerns or questions you might have regarding Botox and other potential pain treatments.
Finding the Right Specialist
Botulinum toxin’s ability to temporarily block the neurotransmitter that allows motor nerves to communicate is an exceedingly versatile medical tool when applied intentionally and with great care. But it’s not a wonder drug. Not all examples of nerve or muscle-related pain can be treated with Botox. In many cases, temporary pain relief may not necessarily guarantee long-lasting relief.
Botox may be part of a larger treatment plan, often including the use of other medication (from over-the-counter anti-inflammatory drugs to antidepressants and muscle relaxants), physical therapy, and other injectables (such as neurolytic nerve blocks).
When considering Botox for pain, it’s important to talk to the right specialist. Find a pain management clinic that specializes in nerve and muscle pain. Ask for an expert on Botox injections and similar interventions for pain. They can identify whether Botox would help your case, and refer you to other specialists if it would not.
Modalities like Botox injections can greatly improve a person’s quality of life. Incessant neck and head pain especially can be reduced. Conditions like chronic migraine can be debilitating, inducing constant fatigue, and disabling a person from participating in society.
But be wary of experimental or off-label treatments. Pain, let alone the circumstances around it, is very complex. Listen to the specialists and ask any questions you may have.
Schedule an appointment today with PMIR to discuss if this treatment is right for you.
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