Are considering having a Botulinum Toxin Injection (Botox) or have one planned? It’s important to know all you can about it.

What is the problem?

You have a painful condition affecting one or more muscular areas. This is usually due to a tender spot in a muscle, where the muscle has a small ‘knot’ in it. This muscle knot may be the result of an injury. It may be caused by an inflammatory or degenerative condition. Inflamed joints are one example, where the overlying muscles become stiff and painful. It is not always clear why these trigger points develop. They can be associated with various illnesses, including myofascial pain and chronic fatigue states. Sometimes a muscle can be in spasm after a stroke. Some headaches, including migraines, can be related to muscle spasm. These illnesses can be treated with botulinum toxin injections.

The pain may be related to an underlying inflammation. Often it is due to the lack of use of a muscle, when pain of whatever cause has been present for a long time.

What is a botulinum toxin injection?

Botulinum toxin injections are used to treat many different painful conditions. The injections are usually given into a trigger point. This is a particular spot in the muscle that ‘triggers’ or starts off the pain. The needle is passed through the skin and tissues, into the trigger point. The botulinum toxin can then be injected into the trigger point. Painful conditions affecting one or more muscle areas can be treated with one or more injections. Only a small amount of botulinum toxin is needed. This is far below the amount that could cause you harm.

What is botulinum toxin?

Botulinum toxin is the purified extract of a poison from bacteria. When injected, it blocks the messages sent from the brain to the muscles, telling them to contract. When muscles stay contracted they become painful. By blocking these signals, botulinum toxin makes the muscles relax. Over several months this blocking effect wears off, allowing the muscles to contract again. By this time, it is hoped that the muscle will contract normally and not go into spasm or cramp.

The Goal of the Procedure

The aim of the procedure is to reduce the spasm and ‘unknot’ the muscle. This reduces the sensitivity of the trigger point and therefore fewer pain messages are sent. It is hoped this will produce long lasting relief.

Many patients benefit from a botulinum toxin injection, reducing their pain. However, there is a chance that the pain will not improve, will change or will get worse. Some patients will need to have a further botulinum toxin injection. The muscle relaxing effect will continue to work for about 3-6 months. Those patients who get little or no benefit may want to consider other treatments.

Are there any alternatives?

By the time that you have the botulinum toxin injection you should have already tried other, more simple treatments. These include rest, painkilling and anti-inflammatory tablets, and physiotherapy. You may also have tried a transcutaneous electrical nerve stimulation (TENS) machine for your pain. This works by sending soothing pulses across the surface of your skin and along the nerve fibres. These pulses prevent pain signals reaching your brain. They also stimulate your body to produce higher levels of its own natural painkillers (endorphins).

If you do nothing there are several things that may happen:

• With time and rest the pain may settle on its own
• The pain and difficulty in moving may remain the same
• The pain may increase