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Botulinum toxin injection

If you are considering having a botulinum toxin injection or have one planned, it is important to know all you can about it. This includes:

 

  • why you need this procedure

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

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.

 

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.

Botulinum toxin injection

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.

 

What has gone wrong?

It is not always clear why these trigger points develop. They can be associated with various illnesses, including myofascial (my-oh-fay-shul) 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.

 

The aims

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.

 

The benefits

Your pain should be reduced and you should be able to move around more easily. You will be able to perform your daily activities more easily. You will be able to reduce the number of painkilling tablets that you take.

 

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).

 

What if you do nothing?  

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

 

Who should have it done?

The following groups of patients should have the procedure done:

 

  • Patients with easily identified, painful trigger points

  • Patients with permanently contracted painful muscles

  • Patients with some forms of headache, where muscle spasm is involved

  • Patients with muscle spasm of cerebral palsy

  • Patients with muscle spasm from a stroke

  • Patients with spasticity from a birth injury or multiple sclerosis

 

This list lengthens as the technique is successfully tested on more conditions. Your doctor will be able to advise you.

 

Who should not have it done?

Each patient must make the final decision as to whether to proceed or not. If you are unhappy about the procedure for any reason, you should not continue.

 

There are specific medical situations when a botulinum toxin injection should not be done and they are as follows:

 

  • When a patient is on medication (drugs) that prevent blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor

  • When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal

  • When there is infection of the skin over the site where the needle needs to be put in

  • When a patient has an allergy to botulinum toxin

  • When a patient has unstable bony structures under the muscles to be injected

 

Author: Dr Sean White FRCA. Consultant in pain and anaesthesia

© Dumas Ltd 2006

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