Recent studies show that botulinum toxin type A, commonly known as Botox, may be an effective treatment for chronic back pain, even after other treatments have failed.
Botox is best known for its ability to smooth facial wrinkles. However, it is also used to treat a variety of muscle conditions and disorders, including muscular sclerosis and blepharospasm (chronic eye muscle spasms). Studies using Botox to treat such conditions as writer’s cramp and cerebral palsy are also promising. Now it seems that chronic back pain may be added to the list.
Botox is a purified form of the toxin that causes botulism food poisoning. In severe cases of botulism, paralysis may result. Botox is a much weaker concentration of this toxin, and has lesser effects than botulism. It works by attaching itself to nerve endings and blocking the release of a neurochemical responsible for muscle contractions. It may also mute pain signals. Reducing nerve activity in the affected area results in decreased pain and more relaxed muscles.
In studies over the past few years, Botox was injected into the back muscles of patients near the site of the muscular pain. Other patients were given injections of a placebo. The studies consistently showed that two-thirds or more of the patients injected with Botox experienced significant improvement in their pain levels.
The studies have been small, but they exhibit dramatic results. Patients in these studies suffered few side effects, and a majority felt significant relief within four weeks. Among the many studies were experiments with the following results:A study published in 2000 treated fourteen patients with Botox and fourteen with a placebo. After three weeks, eleven of the individuals treated with Botox felt pain relief of greater than 50%; only four of the placebo patients felt a similar level of relief. A 2001 study in Georgia treated 25 patients with Botox, and their pain decreased by an average of 40%. Fourteen of these patients (57%) would go through the treatment again; only 10% would not. Three patients complained of side effects.In a 2001 study of 31 patients, eleven of the fifteen who received Botox felt 50% or more pain relief after three weeks; four of the sixteen placebo patients felt comparable improvement.A study in St. Louis found that all nine of its patients found significant relief, and two of them were still pain-free one year later. None felt any significant side effects.A Vermont study found that all twelve of the patients treated reported a 50% decrease in pain.
Botox is not a permanent solution to chronic pain. The effects typically last from two to four months. After that, a repeat injection may be necessary to extend or repeat the results. When combined with physical therapy, the effects of Botox may be greater and last longer.
Back pain affects 90% of adults at some point in their lives and is responsible for about 20% of military discharges. It also costs the American economy about $50 billion per year.