Use of Botox in Painful Neuromuscular Disorders
The cosmetic drug Botox (botulinum neurotoxin type A) is helpful when used in treating painful neuromuscular disorders because it can stop or reduce muscle spasm by blocking nerve signals to the injected muscle. It is an FDA approved medication injected for the treatment of painful skeletal muscular conditions. These conditions include chronic migraines, cervical dystonia, and upper limb spasticity.
A chronic migraine is when an adult patient (14 years of age or older) experiences a headache which lasts four hours a day, 15 days or longer a month. Your doctor can inject Botox for treatment of migraines along the bridge of the nose, the temples, the forehead, the back of the head, the neck, and the upper back. The relief provided by these injections can last up to three months. Botox has not been approved for episodic migraine (14 headache days or fewer per month) or for patients under the age of 14.
Upper Limb Spasticity
Upper limb spasticity occurs when your body’s nervous system has been damaged in some way, such as by a stroke, disease (for example, cerebral palsy), or injury. This condition affects the way you move your arms. Symptoms can include spasms, stiff arm muscles, clenched fists, and trouble using your arms. Your doctor can directly inject Botox into your muscle to relax the muscles and ease the spasms. Botox has not been approved for patients with upper limb spasticity under age 18 years.
Cervical dystonia is a rare neurological disorder. Typical symptoms for this condition are involuntary muscle contractions in the neck, which cause abnormal movements of the neck and head. Botox can be used to reduce the severity of abnormal head position and neck pain.
Other conditions associated with dystonia are strabismus and blepharospasm. Treatment with Botox for these conditions are also FDA approved. Strabismus is crossed eyes, while blepharospasm is eyelid spasms. Your eyes have six muscles, with two of these muscles moving the eyes from side to side. With strabismus, one of these muscles weaken, and the stronger muscle will pull the eye in the opposite direction. Doctors will inject Botox into the stronger muscle to relax it, thus giving the weaker muscle a chance to recover. Botox can also be used for people who have blepharospasms (eye spasms).
Lower Back Pain
Botox may also be useful in treatment of lower back pain. Experimental studies have shown that pain relief from Botox injections lasted three to four months.
Temporomandibular Joint Syndrome
Botox used for the treatment of Temporomandibular Joint Syndrome is still experimental. Botox may relieve jaw tension, which could lead to tension headaches and jaw pain.
Chronic Anal Fissure
Anal fissures are tears in the anal canal that cause pain during a bowel movement. Botox injections in the internal anal sphincter can relieve symptoms for up to three months, giving the fissures to heal and the symptoms to go away.
Botox has also been shown to be effective in other conditions, such as tennis elbow, pain after mastectomy and hemorrhoidectomy, and chronic prostatic pain.
Dr. Luis Fandos is a pain management physician from Long Island, NY.