If you have not heard of Botox as a pain management treatment, you may be surprised to learn that this popular treatment for wrinkles also has applications for chronic pain.  Botox therapy involves injections of botulinum toxin, a neurotoxin produced by various bacteria.  Botulinum toxin inhibits the binding of the neurotransmitter acetylcholine, causing flaccid paralysis in a localized area.

In addition to inducing muscle paralysis, botulinum toxin also interferes with the normal activity of neural pathways. In its natural state, botulinum toxin is one of the most potent poisons known to mankind.  However, if managed properly, this toxin has proven effective for many health conditions including

  • Eyelid spasms
  • Neck and shoulder muscle spasms
  • Excessive sweating
  • Post-stroke upper limb spasticity
  • Overactive bladder
  • Facial wrinkles

The Mechanism of Botulinum Toxin

 The ability of botulinum toxin to inhibit neural transmissions has made it a valuable pain management treatment for conditions like migraines, myofascial syndrome, arthritis and neuropathic pain.

Your nervous system requires acetylcholine to control muscles that govern activities like breathing and movement.  This neurotransmitter is the primary way that nerves communicate with muscles.  Botulinum toxin acts on at least four sites within the neuromuscular junction, preventing transmission of acetylcholine to receptors in the muscles.  This induces muscle relaxation and paralysis.

The effects of Botox on muscles makes it one of the most potent pain management treatments for chronic pain conditions related to muscle spasms.  By paralyzing overactive muscles, Botox is able to relieve tension and pain.

How Botox Therapy Works

There are other potential pain applications for botulinum toxin.  Researchers in the UK report that injecting botulinum toxin into the spines of mice blocks the transmission of pain signals.  After a single injection, test subjects exhibited pain-free behavior for up to a month. This application has not yet earned approval for use in humans.

The actual process of preparing and administering a Botox therapy is relatively simple.  It involves the following steps:

  • Botulinum toxin is harvested from cultured clostridium botulinum bacteria.
  • The desired toxin is purified and diluted for clinical use.
  • Without anesthesia, the botulinum toxin is injected into the area that is to be affected.

Risks Associated with Botox Therapy

It may take up to seven days for the therapy to take effect.  Botox therapy effects typically last from four to six months, at which time, the therapy can be repeated.

Although Botox has been used by clinicians for more than a decade, it is not without potentially serious side effects. One should keep in mind that botulinum toxin is a very powerful poison, and that the amount used for pain management treatments is higher than that used in cosmetic treatments. 

Before you choose Botox therapy for your chronic pain, you should consider the following:

Botox for Migraines

One of the more important pain management treatments involving Botox is for migraine headaches. In fact, Botox therapy is the only FDA-approved treatment for people who experience 15 or more migraines per month. Studies show that those who had the treatment had fewer migraines and other kinds of headaches. In some cases, the total number of headache days was cut in half.

  • The most common side effects of this treatment include nausea, bruising, indigestion and muscle weakness.
  • In some rare cases, botulinum toxin has been known to spread beyond the injection site leading to serious health complications including
    • Vision problems
    • Difficulty speaking or swallowing
    • Respiratory issues
    • Bladder control problems
  • If you are pregnant or breastfeeding, you should not undergo this procedure due to risk of spreading the toxin to the child.
  • A small fraction of people are allergic to botulinum toxin and may experience mild to severe, and, even, life-threatening reactions. Closely monitor any symptoms following an injection and alert your physician if any uncommon reactions appear.
  • Discuss your physician’s history of Botox use for pain management.  If they are relatively inexperienced, ask for a referral to a doctor with more specific expertise.
  • Honestly discuss all medications you are taking with your physician to prevent any potential cross-reactions.  If you are on blood thinners, you may have to discontinue them a few days prior to the procedure.

Botox for Chronic Muscle Spasms

Medical researchers believe that Botox interferes with the neural pathways in the head and neck that initiate migraines.  This interference prevents migraine headaches from starting. It may take one or two sessions involving up to 30 or 40 shots each before you see any improvement.

Due to its ability to sooth overactive muscles, Botox therapy is an ideal pain management treatment for muscle spasm conditions like twitching facial muscles, lazy eye, or cervical dystonia. A course of treatment is typically between 5 and 10 injections, but this may vary depending on the exact condition and the number of muscles affected. Effects typically last a few weeks or months before re-application is necessary.

Botox for Neuropathic Pain

Some studies show that Botox therapy is as successful as 95 percent among patients with facial spasms.  It has also proven successful among patients with lazy or crossed eyes (where eye control muscles are continuously contracted). 

A study published in Lancet Neurology in February of 2016 found that among 66 patients suffering from post-surgical neuropathic pain, those who received at least two injections of botulinum toxin had a significant reduction in neuropathic pain symptoms. 

The effectiveness of Botox therapy is especially good news for people suffering from neuropathic pain. Currently there are few successful pain management treatments for neuropathic pain, so the findings that botulinum toxin may sedate overactive nerves is important for this group of chronic pain patients.

After taking tissue samples from the study participants, researchers concluded that the botulinum toxin interacts directly with pain-sensing nerves and numbs them.  They went on to suggest that additional research is necessary to identify the specific subtype among the more than 40 varieties of botulinum toxin that neutralizes pain sensors. It may even be possible to isolate a botulinum toxin subtype that numbs neuropathic pain without paralyzing surrounding muscle fibers.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information. 

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