Using Botulinum Toxin (Botox) for muscle spasms and pain can be effective in reducing excessive muscle tone, associated pain, and deformity. The toxin has a high patient acceptance compared to systemic medications. Improvement occurs within a week and its benefits last for months. In addition, you can use botulinum toxin in conjunction with physical therapy. More aggressive therapeutic exercise is tolerated during the response phase. Pain relief usually lasts 4-6 months. In some cases, no further treatment is necessary after the muscles have been adequately stretched. Botulinum Toxins can manage the following conditions:
- Cervical Dystonia. Cervical dystonia is a movement disorder that consists of involuntary contractions of the neck and shoulder muscles, which produce pain, spasm, and abnormal head positions. Botulinum toxin is considered the first line therapy for mild, moderate, and severe symptoms of cervical dystonia. The condition is more common in females, and has a mean age of onset of 42. It can be caused by hereditary neurological syndromes, environmental conditions (trauma, perinatal injury), Parkinsonism and psychogenic conditions. The most common head posture in cervical dystonia is torticollis, where the head rotates to one side. The sterilized toxin is FDA approved and is covered by most PPO insurances.
- Blepharospasm, strabismus, and hemifacial spasm. Other FDA approved indications for Botox include blepharospasm, strabismus, and hemifascial spasm. Blepharospasm is a localized movement disorder that affects the muscles that control eyelid movement. The disorder is characterized by increased blinking caused by involuntary spasms of the eyelid muscles. An injection of Botox directly into the affected eye muscles can relieve these spasms.. Strabismus is a deviation in eye alignment. Esotropia is the most common form of the condition and occurs when the eye turns toward the nose. Injecting Botulinum Toxin into the muscle that’s pulling the eye inward or outward can help correct the problem. Hemifacial spasm is a neurological disorder in which blood vessels constrict the 7th nerve and cause various degrees of spasm. Botox controls these spasms in more than 90% of cases.
- Musculo-Migraine type headaches. Botulinum Toxin is FDA approved for treatment of musculo-migraine headaches when medications have become ineffective and the headaches have increased in both frequency and intensity. We have had excellent results with treatment of Botox for migraine headaches. Typical dosage for treatment range from 100-200 units of Botox.
- Hyperhidrosis- Excessive sweating of the hands, feet, and underarms. Focal hyperhidrosis is a common condition associated with excessive sweating. It usually involves the palms, underarms, face, or feet. Affected patients may routinely soak through clothing in minutes, and resort to pads, shields, absorbent tissues, and frequent clothing changes to cope with the disorder. Hyperhidrosis also has a significant psychological effect on the patient. Typically, the patient has difficulty with social behavior in public such as shaking hands. Often they are passed over on employment due to the excessive sweating. Intracutaneous injections of Botox abolishes focal hyperhidrosis by preventing the presynaptic release of acetylcholine in nerve endings. When nerves are blocked, sweating decreases dramatically. The optimal effect can last 4-12 months. Dr. Jagodowicz specializes in treatments for hyperhidrosis and is well regarded in this field.
- Temporomandibular disorders (TMJ). Temporomandibular disorders consist of myofascial pain, internal derangement of the joint and degenerative joint disease. Treating these disorders with Botulinum Toxin has improved the associated myofascial pain. The toxin is injected into the lateral and medial pterygoids, as well as the temporal and masseter muscles. The results are dramatic for patients with limitations opening the mouth.
- Back pain and spasms-Failed back syndrome. Post-traumatic myofascial pain syndrome, piriformis syndrome, paraspinous syndrome, and chronic back spasms respond well to Botox. In addition, patients with repetitive strain injuries have benefited from its effects.
This article is a reprint from the March issue of Advance Rehabilitation, Muscle Power by Morris Jagodowicz, M.D. If you are interested in treatments for pain with Botox, contact our office at (818) 360-4949.