Neck pain and botox
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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From the Botox website...
Botox® belongs to a class of drugs called botulinum toxins.
Botox®, a focal muscle-relaxing agent, is the brand of botulinum toxin type A made by Allergan. Botox® is the most studied brand of botulinum toxins and has been used to treat over 1 million patients worldwide for more than 11 years.
Botox® is a formulation of botulinum toxin type A. It is derived from the bacterium Clostridium botulinum. This bacterium produces a protein that blocks the release of acetylcholine and relaxes muscles. Type A is just one of seven different types of botulinum toxin (A, B, C1, D, E, F, and G), and each has different properties and actions. No two of these botulinum toxins are alike.
More than 100 years of research have expanded our knowledge of botulinum toxin type A from the identification of the bacterium Clostridium botulinum to the commercialization of botulinum toxin type A as Botox®.
In the 1960s, the muscle-relaxing properties of botulinum toxin type A were tapped for investigational use in realigning crossed eyes. These early studies paved the way for treating other conditions caused by overactive muscles with botulinum toxin type A.
Today, Botox® is produced in controlled laboratory conditions and given in extremely small therapeutic doses. It has helped over 1 million patients worldwide with conditions caused by overactive muscles.
Botox® is indicated for the treatment of cervical dystonia in adults to decrease the severity of abnormal head position and associated neck pain. Botox® is also indicated for the treatment of blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in people 12 years of age and above.
Botox® has a product license for the following conditions:
• Cervical Dystonia - severe muscle spasm in the neck and shoulder muscles leading to neck pain and abnormal postures
• Strabismus / Blepharospasm - involuntary muscle spasm around the face and eye
It is also used outside this license for the following conditions:
• Myofascial Pain Syndromes - pain arising from skeletal muscles in spasm e.g. neck, shoulder girdle, low back, and hip girdle.
• Spasticity - caused by brain and spinal cord injuries
• Sweating - Botox treatment can help control excessive sweating
• Migraine - when the source of the migraine is the neck or facial muscles, injecting intramuscular Botox can help to relax the offending muscles for several months, thereby helping to relieve the pain.
Botox® blocks neuromuscular transmission (electrical conduction from nerve to muscle) through a three-step process. This is believed to be followed by the sprouting of new axon (nerve) terminals, which results in the re-establishment of neuromuscular transmission. The following information regarding the mechanism of action of Botox® is based upon animal data, thus the clinical significance is unknown:
Blockade of neuromuscular transmission
• Binding - Botulinum Toxin Type A binds to the motor nerve terminal (where the nerve attaches to the surface of the muscle). The binding site of the type A molecule appears to be selective for cholinergic nerve terminals, receptors that bind to the impulse transmission chemical, acetyl choline.
• Internalisation - Botulinum toxin type A is taken into the nerve terminal by a process called endocytosis, to form a toxin-receptor vesicle (bubble). The light chain of the molecule is then released into the fluid centre of the cell (cytoplasm). This light chain has been shown to hold the nerve transmission blocking properties.
• Blocking - Botulinum toxin type A blocks acetylcholine release by cleaving SNAP-25, a cytoplasmic protein that is located on the cell membrane and that is required for the release of this transmitter. The affected terminals are inhibited from stimulating muscle contraction. The toxin does not affect the synthesis or storage of acetylcholine or the conduction of electrical signals along the nerve fiber.
Re-establishment of neuromuscular transmission
• Nerve Sprouting - Evidence indicates that chemical denervation of the neuromuscular junction by botulinum toxin type A results in an expansion of the end-plate region and growth stimulation of collateral axonal sprouts.
• Nerve Connection Re-established - A nerve sprout eventually establishes a new neuromuscular junction, and muscle activity gradually returns. However, new research suggests that this new nerve sprout retracts and the original junction returns to functionality. In either case, repeat injections of Botox® Purified Neurotoxin Complex may be required to maintain the desired clinical effect.
So how does this help neck pain?
A new study shows that Botox injections may significantly reduce chronic neck pain when used in combination with physical therapy.
Researchers say the results of a small study show that Botox may also be a useful addition to physical therapy to relieve neck pain caused by chronically contracted muscles.
In the study, published in the January issue of the American Journal of Pain Management, researchers looked at the effects of combining a single injection of Botox delivered to the affected neck muscle with standard physical therapy in 25 people with chronic neck pain.
After three months of follow up, the participants were asked to rate their neck pain on a scale of one to 10. The study showed that the combination treatment reduced self-reported pain scores significantly, from about a six at the start of the study to a four by the end, an average reduction of nearly 40%.
More than 50% of the patients who participated in the study said they would undergo future Botox injections for the same problem.
The findings are consistent with previous studies that have shown Botox injections can relieve pain caused by other muscle-related conditions, such as cervical dystonia and spasticity (neck muscle stiffness and spasms). These studies show that the duration of pain relief offered by Botox varies from about three to- six months, depending on the disorder.
Researchers say that since this study did not compare the effectiveness of Botox combined with physical therapy versus physical therapy alone, it offers only indirect evidence that the injections enhanced the rehabilitation efforts. But they suspect that using Botox to relax the muscle before therapy maximizes the potential for rehabilitation and repair of damaged muscle tissue, strengthening of weakened muscles caused by spasms, and relieving pain.
Researchers says treating neck pain with Botox injections may also have an advantage over oral pain medications because the effects of the injection are local and does not cause the type of side effects commonly associated with oral pain medications, such as sedation, fatigue, and dizziness.
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