Botulinum Toxin Injection (BOTOX)
What is Botox?
Is a term use to describe a substance known as Botulinum Toxin, which is made by the Clostridium botulinum bacteria. It is the same bacteria, which causes botulism. A major difference resides in the fact that, the Botox substance is inactive and made for medical use. The concentration is extremely low, thousand of times lower than required to cause botulism.
How Does Botox work?
The mechanism of action is dual. One, it creates gradual muscle relaxation in the pain muscle areas. Two, it slows down the neuro-chemical process responsible for pain transmission by small nerves. The reduction of pain and muscle spasm can last up to 4 months.
What Are the Indications for Botox Injections?
Painful Musculoskeletal conditions that have responded to local anesthetic injections, although short term are potential uses of Botox. Some conditions that may respond to Botox injections are: muscle contraction headaches, occipital headaches, chronic painful spasm in the neck and low back, torticolis (severe neck spasm), spasticity from Multiple Sclerosis or stroke and Myofascial pain syndromes.
There are several toxins produced by the bacterium Clostridium botulinum. Botox® is a Type A strain, while the newer Myobloc® is a Type B strain. Although Botox® and Myobloc® have different mechanisms of action they both effectively reduce painful muscle spasm. Gradual relaxation of muscle spasm develops over one to two weeks after the injection of either agent. The reduction of muscle spasm lasts for 3-4 months and pain relief can last even longer. Conditions that are treated with Botox botulinum injections (Botox or Myobloc) include muscle contraction headaches, chronic muscle spasms in the neck and back, torticolis (severe neck muscle spasms), myofascial pain syndrome, and spasticity from multiple sclerosis or stroke.
The procedure can be performed as an outpatient, in the office, hospital and out patient surgical facility. Usually the procedure is performed under local anesthetic alone. Some patients that are apprehensive may benefit from intravenous sedation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied.
Next, the skin overlying the painful muscle(s) will be cleansed with a sterile solution. A solution of the botulinum toxin and a local anesthetic is then injected in the appropriate muscle.
After the Procedure
You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 according to response. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. Immediately after the procedure, you will be evaluated to assess for specific response. A post procedure evaluation form to assess the effectiveness of the injections will be given to the patient prior to discharge. Post procedure instructions will be given in a pre-printed form.
Occasionally you may experience temporary numbness and weakness in the arm or leg according to the location of the injection. Also, temporary side effects from the injections may include increase in pain, weakness in the muscles injected, body aches, dry mouth, and hoarseness. A follow up appointment will be made for follow up and to determine if a repeat injection may be necessary. Frequently, according to your specific response, more injections may be indicated. It is not advisable that you drive the day of the procedure.