Botox back pain



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Low back pain is a ubiquitous problem in society. And the search for alternatives to surgery has prompted a look at some novel ideas. One such is the use of Botox.

Botulinum toxin A (Botox™, Allergan Inc.) injection to the piriformis muscle appears to be an effective treatment for low back pain and sciatica caused by piriformis syndrome.

Piriformis syndrome is a primary or contributory cause of sciatica and low back pain, according to Dr. Serosh Saleemi, from the department of anaesthesia at Louisiana State University Health Sciences Center, in Shreveport, United States, and colleagues.

Botox acts presynaptically by inhibiting the release of acetylcholine, leading to functional denervation of the muscle for up to 6 months.

Presenting their findings here October 15 at the 55th Annual Meeting of the American Society of Anesthesiologists (ASA), Dr. Saleemi's team conducted a retrospective review of 50 patients who underwent Botox injections in the piriformis muscle.

Criteria used to diagnose piriformis muscle syndrome included gluteal pain, muscle spasms or pull in leg muscles, positive Beatty's Maneuver, and L5 or S1 sensory nerve root hypoaesthesia of A-delta fibers on the affected side. A standardised preparation of 100 Units of Botox in 5 cc of preservative-free 0.9 N saline was injected into the piriformis muscle under fluoroscopic guidance.

All patients reported a reduction in pain score after six to eight weeks of follow-up, the researchers reported.

Average visual analog scale (VAS) score for pain was nearly 8.87 prior to treatment and 4.5 points after treatment (p<0.01). Average McGill score, which was measured in 27 patients, was 40.6 before and 21.5 after the injection (p<0.01). Oswestry score, also in 27 changed from 25.9 to 11.7 (p<0.01) and Roland-Morris score decreased from 16.0 to 20.6 (p<0.01).

"We propose that Botox injection to the piriformis muscle is an effective treatment for low back pain and sciatica caused by piriformis syndrome," the authors concluded.

"Piriformis syndrome is quite common and an important cause of low back pain," Dr. Saleemi told Doctor's Guide. He claims that, when diagnosed correctly, piriformis syndrome improves in more than 90 percent of cases when treated with Botox.

"This treatment lasts for at least three months, and when administered with the fluoroscopic technique, it is very easy to administer," she said.

Ultrasound needle guidance may actually be better since the muscle and fascial planes can be seen and there is no radiation involved.

Numerous other studies have confirmed the effectiveness of Botox for chronic low back and neck conditions where the underlying cause is arthritis and the secondary effect is chronic muscle spasm.

What is uncertain at this time is whether the effect of Botox is due entirely to its effects on muscle spasm or whether there is another effect on pain receptors as well.

Other studies have continued to demonstrate the effectiveness of botulinum toxin for low back syndromes.



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