Botox for Treating Pain

by Christina Lasich, MD Health Professional

Considering Botox? Botox is not just for cosmetically removing wrinkles; Botox is also used to treat spasticity and pain. In order to understand its medicinal uses, one needs to understand that Botox (OnabotulinumtoxinA or Botulinum Toxin Type A) is a neurotoxin that interrupts the messages between the nerves and the muscles. This chemical compound is produced by Clostridium Botulinum. This bacteria causes a disease called botulism, a type of life-threatening paralysis caused by poisonous doses of the boltulium neurotoxin.

Somehow someone (probably a brave sole) discovered that in very small, localized doses, Botox smoothes wrinkles. Everyone seems comfortable with and accepts the cosmetic purposes of Botox injections. Because the underlying mechanism is to relax muscle activity, many other uses for Botox are also being explored. Of interest, Botulinum Toxin Type A can help to control pain and muscle hyperactivity. However, many have questions about the therapeutic uses of this neurotoxin for treating spasticity and pain. After the questions have been answered, the decision to use Botox for pain needs to be based on a clear understanding of the risks and limitations of this potentially dangerous toxin.

The risks for using Botox fall into three main categories: inherent, generalized, and localized risks. The inherent risks are based on the fact that this medicine is administered by injection. Anytime a needle is involved and the protective barrier of the skin is broken there is a risk of infection, bleeding, and bruising. Generally speaking, this toxin can also cause some major problems if too much is given or too much enters the blood stream. Because this is the same toxin that causes Botulism, the generalized risks are life-threatening, such as shock and respiratory failure. Although these generalized risks are rare to localized treatment, they do exist.

Most of the time, focused injections of Botox to a specific treatment area have risks limited to the immediate treatment area. Those who receive injections in the neck expect a risk for developing difficulty swallowing. Those who receive injections near the eye expect a risk for developing double vision or droopy eye lids. Probably the most important, yet commonly overlooked, risk is the development of immunity to the Botulinum Toxin Type A. Although immunity sounds good, in some cases it is not. Those who receive numerous Botox injections for cosmetic reasons may someday really need Botox for pain and spasticity. If immunity has developed, then the Botox will lose its effectiveness for all therapeutic indications. The risks of using this neurotoxin are complicated, numerous and based on where the injections take place. Before electing for Botox, talk with the treating doctor at length about the risks and potential benefits.

Besides risk, Botulinum Toxin Type A has certain limitations. First and foremost, this neurotoxin is not a cure. The therapeutic effects wear off and repeat injections are necessary for continued benefit. One can expect the beneficial effects to last three to six months. The need for repeat injections adds up to increased cost and risk. Many people question the cost effectiveness of using this costly neurotoxin. Take a look at the numbers for one typical session: One vial of Botulinum Toxin Type A can cost $1000, one session of Botox injections for pain and spasticity takes, on average, one to three vials. This means that each session can cost upwards of $3000 for the medication alone. $3000 every three to six months is a hefty, hefty price for temporary relief. Cost is the major limiting factor for using Botox to treat pain.

Well, at this point, the Botox bandwagon has already left the barn despite the risks and limitations. Are you ready to hop on board the Botox wagon? Many controversial studies suggest the potential for this toxin to relieve many types of pain including: pelvic pain, neck pain, headaches, joint pain, and back pain. This list is growing because the ability to disconnect the muscles from a hypersensitive nervous system is a powerful tool. And turning off the hyperactivity of muscles can and does most definitely improve quality of life in some individuals. With quality of life in the balance, one needs to decide whether or not the high cost and risk is acceptable for a temporary fix. No matter what one decides to do, ultimately, the truth is that Botox is not a cure for anything or anybody.

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.