Jonathan Aarons M.D.

Tired of Chronic Pain?

Botulinum Toxin for Chronic Pain Management

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Most people are familiar with Botulinum Toxin, or BoTox, for cosmetic surgery but many are not aware of its application for the management of chronic pain.   It can be used for migraine as well as cervical dystonia among others.  We know that botulinum toxin prevents the release of acetylcholine from the presynaptic vesicles at the neuromuscular junction.  This accounts for its ability to decrease wrinkles.  Its mechanism for the treatment of chronic pain is not so well elucidated.

Cervical dystonia, or spasmodic torticollis, is a disorder of the muscles of the neck and shoulders. The injection of botox into these muscles will weaken the muscle and diminish abnormal muscle movements and contractions.

Chronic migraine is another painful condition that is often difficult to treat.  Studies have shown that botox type A can decrease headache, both in frequency and severity.

There are other painful conditions that can be treated with botox, but for which the evidence is not so strong.  These include myofascial pain,  temporomandibular dysfunction (TMJ), pyriformis syndrome, lateral epicondylitis ( tennis elbow), plantar fasciitis, chronic pelvic pain, interstitial cystitis, trigeminal neuralgia, post herpetic neuralgia and others.

The use of botulinum toxin for chronic pain management is not without risk.  These risks include infection, swelling, redness, allergic reaction and muscle weakness.  This muscle weakness can including trouble swallowing, blurred vision, drooping eyebrows, dry mouth among others.  The consideration of the use of botox should be made with the consultation of your pain management professional.

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