Botox injections are a non-surgical treatment that alleviates pain by relaxing the muscles.
Botox injections make therapeutic use of the botulinum toxin type A, a toxin produced by a bacterium called Clostridium botulinum. Small amounts of the toxin, when diluted, can be safely injected into muscles to relieve pain.
Botox works by blocking certain nerve signals that control muscle activity and can be used to treat uncontrolled muscle contractions and to relax chronically contracted muscles.
Musculoskeletal Pain
It is well known that Botox works to treat muscle spasms by inhibiting the release of acetylcholine at the nerve terminal within the muscle. This inhibition reduces muscular tone and overactivity – essentially relaxing the muscle. Botox is therefore effective in painful muscular conditions resulting from muscular spasms, contraction or overactivity, such as myofascial trigger points and some cases of myofascial pain syndrome.
Low Back Pain
Whilst there have been very few studies on the effectiveness of Botox in low back pain, a role for this treatment has been suggested for chronic low back pain of muscular origin, particularly when due to overactivity or stretch of the deep paravertebral muscles. One small study has shown promising results, however, large, controlled clinical trials are needed to provide with stronger support for this clinical application.
Chronic Inflammatory and Neuropathic Pain
Besides providing pain relief via its muscle relaxation effects, numerous studies have shown or suggested that Botox may also inhibit the release of several other neurotransmitters and/or interrupt other peripheral and central nervous system pathways involved in pain perception and signalling. There is a suggestion that Botox plays a role in the activation of the endogenous opioid system. These actions may underlie the effectiveness of Botox in relieving inflammatory pain and neuropathic pain.
Preliminary data from small or pilot studies has provided support for effective pain relief with Botox treatment in complex regional pain syndrome, postherpetic neuralgia (pain following a shingles outbreak), brachial plexopathy (pain/dysfunction in the shoulder/arm usually due to nerve injury) and spinal cord injury. Recently, a randomised, double-blind, placebo-controlled trial has provided strong evidence for the effectiveness of Botox in the treatment of peripheral neuropathic pain of various causes, particularly in the reduction of allodynia.
Migraine & Headache
Botox has also been shown to reduce sensory activity in the facial muscles arising from the cranial nerve and inhibit sensitisation in the face produced by the trigeminal nerve. These mechanisms are thought to underlie the potential effectiveness of Botox injections in relieving or preventing migraine/headache. Numerous studies have been conducted in patients suffering from migraine as well as chronic headaches, tension headaches and other headache syndromes that have shown positive results, however, large, controlled clinical trials are still warranted.
What to expect during the procedure?
The procedure is quick and simple, the pain specialist numbs the skin where the injections will be administered, using local anesthetics. A thin needle is then used to inject Botox into the targeted muscles. It is recommended that the patient organises a lift home and rest for 24 hours after the injection. The local anaesthetic will wear off in roughly 12-18 hours and the Botox should take effect approximately 5 days post-injection. The benefits typically last for 3 months. Repeat injections are required to maintain long-term relief.
Risks associated with Botox injections
The injections are always administered under the care of a doctor to reduce the risk of side effects. Side effects are generally non-serious and there is no evidence for serious long-term effects with repeated injections. Common side effects include initial discomfort at the injection site, bruising around the area of the injection, swelling, temporary exacerbation of pain, muscle weakness, headache and flu-like symptoms.
How to prepare for the injections?
Before making an appointment for the procedure, patients must tell the pain specialist about any Botox injections that have been performed in the previous 4 months, as well as any medications he/she is currently taking.
The pain specialist may instruct patients to pause certain medications, like blood thinners, for a few days before the treatment to avoid side effects like bruising.
Patients may also be asked to refrain from drinking alcohol for a few days after the procedure.
Post-treatment
There is no recovery time associated with Botox injections, and patients can go home immediately following the procedure. It is recommended that the patient organises a lift home and rest for 24 hours after the injection. The local anaesthetic will wear off in roughly 12-18 hours and the Botox should take effect approximately 5 days post-injection.
After getting the injections, it’s important to avoid massaging or rubbing the area for at least 24 hours to ensure that the injected substance does not spread to unwanted areas.
Most individuals typically experience pain relief a few days after the procedure which can last anywhere from 3 to 6 months. Pain relief is not permanent, however, and repeated injections are required to maintain long-term effects.
