BOTOX – relief for Myofascial Pain

Krishna Baddigam, MD
Pain Management
Pain Clinic of Northwestern Wisconsin
Eau Claire

Myofascial pain syndrome (MPS) is a chronic pain condition that affects the muscles and the connective tissue (fascia) covering the muscle.  This pain can affect one muscle or a group of muscles.  There are many causes for the muscle pain including injury, repetitive motion, fatigue or lack of motion.  Myofascial pain may be characterized by what are called trigger points – areas of persistently contracted muscle tissue that can cause either local or remote (referred) pain. A physician or physical therapist can locate these points through a careful physical examination. Trigger points can be treated in a variety of ways, including physical therapy, application of heat/ice, massage therapy, oral medications, and injections.  The mainstay of interventional therapy is the use of a targeted injection of local anesthetic (with or without the addition of a corticosteroid) directly into the trigger point.  The local anesthetic provides immediate pain relief by blocking pain transmission and also causes muscle relaxation in the area of the injection.  Corticosteroid acts as an anti-inflammation agent and may help prolong the duration of benefit.  However, the length of pain relief in some patients may be shorter than desired.  In these patients, Botox may be an option that can provide a longer analgesic response.

Botox is the manufacturer’s brand name for a product developed from botulinum toxin type A. A bacterium, Clostridium botulinum, produces this toxin, and it has long been associated with cases of serious food poisoning called botulism. Botulinum toxin works by blocking our nervous system’s ability to initiate muscular contraction.  A tiny amount of the purified toxin, carefully delivered to an appropriate target muscle, can cause a relatively long-lasting block of motor function and has been successfully used to treat disorders related to abnormal or undesirable muscle contraction. 

The FDA first approved  Botox  for  clinical  use in 1989  to  treat strabismus (a disorder of eye alignment). In 2002, Botox was approved for use in cosmetic treatment to relax certain facial wrinkles. Since it’s introduction to clinical use, Botox has been the object of research to determine if it can be used as an alternative to trigger point injections for patients with rapid return of symptoms.

Studies on Botox in treating MPS have had mixed results.  There is still ongoing research needed to fully determine which patients are likely to respond to Botox injections.  It is clear that some patients do obtain months of relief following treatment.  However, only a qualified health care professional can determine if an individual, based on their history and a physical exam, is an appropriate candidate.  In addition, most patients will generally need to have demonstrated a satisfactory response to traditional trigger point injections with local anesthetic before Botox should be considered.  Some insurance companies classify the use of Botox for MPS as “investigational” and will not provide coverage of the treatment. 
Make sure you talk to your health care provider and insurance representative before receiving Botox.

Once considered a public health threat, Botulinum toxin, in the form of Botox, is a potential source of pain relief for many patients who have not responded to conventional treatments.  Used judiciously in carefully selected patients, Botox can provide safe and effective long-term treatment that relieves pain and improves both function and quality of life.

For information or to schedule an appointment with Dr. Baddigam,
Pain Clinic of Northwestern Wisconsin, call 888.235.PAIN (7246)
or  visit www.painclinic-nw.com.  Dr. Baddigam sees patients in
Eau Claire, Menomonie, Rice Lake and St. Croix Falls.