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BOTULINUM
INJECTIONS FOR PAIN
Botulinum
toxin is a complex protein produced by the anaerobic bacterium,
Clostridium
botulinum. “botulinum”
injections can be used to treat
various focal
muscle spastic disorders
and excessive muscle contractions
such as
dystonias,
spasms, etc. It has also been proven
to
be effective
in treating chronic neck and
back pain as well as
chronic headaches.
Botulinum
toxin blocks neuromuscular conduction by binding receptor sites
on motor
nerve
terminals, and inhibiting the
release of acetylcholine. When
injected
intramuscularly or
subcutaneously at therapeutic doses, botulinum toxin
produces
local
paralysis and allows
individual muscles
to be weakened selectively. It has the
advantage
of being a
potent
neuromuscular blocking agent with good selectivity,
duration of action,
with few side effects.
Botulinum
toxin can be used to reduce spasticity or excessive muscular
contractions
to
relieve
pain; assist in posturing
and walking; allow
better range of motion; to permit
better physical
therapy; to reduce
severe spasm in order to
provide perineal hygiene.
Botulinum toxin has also
been
successful in reducing the muscle tension involved
with
chronic
headachesand migraine
headaches.
Intramuscular
injection of botulinim toxin has been shown to be safe and relieves
pain
associated with several
movement disorders, chronic myofacial and
cervical pain syndromes.
Increased paraspinal muscle activity has been
implicated as a factor in low back and neck
pain.
Pain may arise
within ischemic overactive muscle itself due to the
build up of
metabolic
waste
products or from structures around the muscle (such as
joints and tendons) stressed
by
persistent muscle tension. Electroymyographic studies often demonstrate increased
electrical
activity of the
paraspinal muscles during activity in patients with
low back pain
compared with
subjects without pain. The possibility
that overactive paraspinal muscles
may contribute to low
back pain
provides a rationale for treatment strategies aimed
at
reducing paraspinal muscle
tone, such as biofeedback and muscle relaxing drugs.
There are risks involved in Botulinim injections. Common side effects
include muscle
weakness
that may affect
function of the limb treated,
local bruising, and discomfort
at the
injection site.
There are other
common side effects related to the particular disorder that is being
treated.
The procedure will consist of the following: You will receive botulinum toxin by injection
into
the
muscle through the
skin. The
skin will be cleaned with an alcohol pad, and the site
may be
determined by using a small electric stimulator
that is called an EMG
machine.
This allows the
physician to correctly locate the muscle to
inject. A small electric
current
may be applied onto
the surface of
the skin or just beneath the surface of the skin or just
beneath the
surface
of the
skin with a small, sterilized needle.
Botulinum toxin may relieve symptoms for three to six months. You
may notice some
improvement within the next 72
hours but may not
notice anything for up to two weeks.
Dystonia is a neurologic
disorder manifested by involuntary , sustained contractions (spasms)
of muscles producing
abnormal postures.
Injections of botulinum toxin type A (Botulinum
toxin)
a protein that causes temporary weakness
of the injected muscles, may
provide
effective relief
for dystonia, hemifacial spasm ( involuntary twitching of one side
of
the face),
spasticity and
other painful conditions due to involuntary muscle contractions.
Studies
involving many
patients
have demonstrated the safety and effectiveness of this form
of treatment.
Botulinum toxin type A, though approved by the FDA for treatment of
blepharospasm
and
hemifacial spasm, has not
been approved in treating dystonias,
spasticity, or muscle pain.
However, the American Academy of Neurology has
deemed this drug safe
and effective
in the
treatment of oromandibular, cervical, spasmodic, and focal dystonia.
In
addition,
the National
Institute of Health has also issued a consensus statement that this
drug is
effective and safe in
treating these disorders.
In addition to dystonia, recent clinical reports in the medical
literature indicate that botulinum
toxin type A treatments
are safe and effective in the treatment of
muscle spasticity (involuntary
spasms often seen after spinal cord injury,
head injury, and other
neurologic disorders).
Patients
that have had head injuries and strokes often have symptoms
with elements of
both
spasticity
and dystonia.
An alternative to botulinum toxin type A therapy would be medications
taken by mouth
such
as
diazepam, benztropine,
clonazepam, baclofen, and others.
Additionally, certain
physical
therapies are known to be beneficial in the disorder as
well.
You may be videotaped prior to and while receiving the medication.
By signing this
consent
form, you give your
permission to have Lynne Carr Columbus, D.O. or her
assistants,
make
photographs, videotapes, and /or recordings of
these injections, under
the condition
that these
photographs, etc., will be used in the interest of medical teaching,
research, or
health science.
These photographs, tapes or recordings and information relating
to your case may be
published
and republished in professional journals or medical books.
The procedure will consist of the following: You will receive the
botulinum toxin type A by
injection into the muscle
through the skin.
The skin will be cleaned with an alcohol pad, and
the
site to be injected may be determined by using
a small electric
stimulator that is connected
to a
battery or a larger machine that is called an EMG machine.
This
allows the physician to
correctly localize the proper area of the muscle to inject.
A small electric current may be
applied onto the surface of the skin or just beneath the surface of
the skin with a small,
sterilized needle. You
will
usually receive three needle sticks to each muscle for even
distribution of the drug, and approximately 0.3 ccs of fluid
(less
than a teaspoon) will be
injected
with each needle insertion.
Botulinum toxin type A may relieve symptoms for three to six months.
You may notice
some
improvement within the
next 72 hours but may not notice anything for
up to two weeks.
If at
any
time you are uncomfortable during the
procedure, please let us
know.
Potential benefits of this treatment would include reduction in
painful spasms, increased
ability
to range a joint such as
the ankle, knee, or arm, potential to
increase the speed
of walking and
other functional abilities, and potential for
certain physical
therapies
to be performed more
easily, such as splinting and casting.
There are risks involve in botulinum toxin type A injections.
Common side effects include
muscle weakness that may
affect function of the limb treated, local
bruising, and discomfort
at
the injection site. There
are other conditions listed
below in which these injections are
performed. The common side
effects related to the following disorders and their
treatments
include:
*For treatment of Blepharospasm ( involuntary eye closing): ptosis (
eyelid drooping),
diplopia
(double vision), burning
and pain, eyelid swelling and
bruising, tearing.
*For treatment of Oromandibular dystonia: dysphasia (swallowing and
chewing difficulties),
dysarthria (talking
difficulty), hoarseness, drooling.
*For treatment of Cervical dystonia: dysphasia, dysarthria, singing
difficulty, neck weakness.
*For treatment of hemifacial spasm: facial weakness
*For treatment of focal
dystonia: hand weakness and foot drop
Rare side effects have
been reported but are not necessarily results of the botulinum toxin.
These include: nausea,
muscle soreness headaches, lightheadedness,
fever, chills,
hypertension,
weakness, difficulty breathing, diarrhea,
and
abdominal pain.
SPECIAL WARNING OF RISK
TO FEMALES OF CHILDBEARING POTENTIAL
The effects of botulinum
toxin type A on human babies are unknown, but could
cause harm.
For this reason, it is
necessary to:
1. Use
adequate birth control to avoid getting pregnant while receiving
treatment.
2. Inform
me immediately if you get pregnant.
This treatment may cause an
allergic reaction. Potentially,
this reaction could be severe
and
life threatening.
As is true of all
medications in medical treatment, there is always the possibility of a
new
or
unexpected risk.
If
you’ve forgotten what it’s like to live without pain, Lynne Carr Columbus, D.O.
understands. She is here to help.
She
will coordinate your treatment with your primary care physician and the
specialists
such
as general, neuro, and
orthopedic surgeons as well as oncologists,
neurologists,
physiatrists,
and psychiatrists.
Feel
free to discuss with your physician whether a referral to
Gulf
Coast
Pain Management
is appropriate for you.
If you have any questions whatsoever regarding
botulinum toxin
and whether or not it may be helpful for your pain,
please do not hesitate to ask Lynne Carr Columbus, D.O.
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