Botox Offers New Wrinkle for Treatment
The treatment is Botox, and it's among one of the newest ways to treat lower back pain.
In numerous studies presented at the just-concluded American Pain
Society conference in Chicago, doctors from across the United States
and Europe offered new evidence that Botox can indeed work in a variety
of situations to treat not only chronic lower back pain, but also
sciatica and even some forms of neck discomfort.
According to rehabilitation physician Dr. Todd Schlifstein, it
offers an important new option, particularly for people who may not
respond to traditional care.
"It's not for everybody or for every type of pain, but when it's
used appropriately, it can offer relief, even when other treatments
have failed," says Schlifstein, a rehabilitation physician at New York
University Medical Center who did not participate in the conference.
Botox is the brand name of a naturally occurring substance known as
botulinum toxin type A. The toxin itself is related to botulism, a form
of food poisoning that occurs when meat or other foods develop a
bacteria known as Clostridium botulinum.
Doctors had long known that in severe cases of botulism, paralysis
results. This occurs when the toxins attach to nerve endings in the
body, preventing the release of brain chemicals that normally control
Using this action as a basis for discovery, doctors soon learned
that in controlled amounts, this same toxin could be used to manipulate
brain chemistry, thus controlling contractions in patients suffering
from diseases linked to severe muscle spasms, such as multiple
However, in tests on patients with MS, doctors soon discovered
something more. When Botox was injected into facial muscle spasms,
wrinkles began to relax -- and seemed to disappear. Not long after, an
anti-aging cosmetic treatment was born.
Soon after that, experimentation involving lower back pain began,
and Schlifstein says the results are proving promising for many
"If the back pain is the result of spasms deep within the muscles,
used in controlled amounts Botox can offer relief lasting at least
three months -- and sometimes permanently -- from a single treatment,"
That's exactly what a number of studies presented at last week's pain conference found.
In the first study, researchers from the A & A Pain Institute of
St. Louis treated six men and three women, aged 36 to 69, who had
suffered from low back pain from three to 12 years. Each found no
relief with traditional treatments, including steroid injections and
Using a "zero to 10" pain assessment system known as VAS (visual
analog scale), each person rated their back discomfort just before
receiving a one-time Botox injection. That injection ranged in strength
from a high of 300 units to a low of 50 units, depending largely on the
size of the muscle.
The result: The average pre-treatment VAS score as 7.3; 12 weeks
after the Botox treatment, pain scores averaged 2.5. After the first
week, pain was reportedly reduced by 50 percent, with additional relief
coming in the following weeks.
Two of the patients had total pain relief by the second week, and
they were still pain-free one year later. All nine patients experienced
significant relief, but three did have some pain return after 12 weeks.
None of the patients had increased pain, and there were no significant
Researchers from The Neurological Research Center in Bennington,
Vt., reported a similar finding after using Botox injections on 12
patients suffering from back pain for an average of 10 years. Five had
previously had surgery, and the remaining seven had tried an assortment
of other treatments -- and none found any relief.
The researchers found that injecting from 100 units to 300 units of
Botox into back muscles reduced pain and discomfort by 50 percent or
more in all 12 patients, with no reported weakness or side effects.
In yet another study presented at last week's conference, doctors
from Burnley General Hospital in England reported they had injected 100
units of Botox into 12 patients diagnosed with sciatica. This is a
unique form of lower back pain causing a burning, radiating ache that
frequently starts in the buttocks and travels to the thigh, knee and,
sometimes, the lower leg and foot. All 12 patients also had restricted
hip movement and all had failed to find relief from previous treatments.
Using three types of measurements to assess pre- and post-treatment
pain (VAS, sleep and daily work activity), as well as a medical exam to
check for flexibility and hip movement, the doctors reported that Botox
offered significant pain relief in all 12 patients.
After a four month follow-up, five patients reported complete pain
relief, while the remaining seven experienced at least a 50 percent
reduction in pain. All the patients experienced increased hip movement
Botox is also being used to treat neck pain as well as migraine.