Botox and Myofascial Pain Syndrome (Fibromyalgia)

10th May 2007 at 16:46 BST by Dr C.A.Jenner MB BS, FRCA. Permalink.

This article highlights the possible role of botox injections in treating the myofascial pain syndrome (fibromyalgia).

Botox and Myofascial Pain Syndrome (Fibromyalgia)

Introduction

Myofascial Pain Syndrome (MPS) is defined as a painful musculoskeletal condition, characterised by the development of myofascial trigger points (TrPs). The trigger points are locally tender when active and refer pain through specific patterns to other areas of the body.

When pressed upon, a trigger point causes pain that is felt elsewhere in the body, which is further known as referred pain. However, it is important to note that there are no trigger points in Fibromyalgia. Instead, Fibromyalgia is widely accepted as a perpetuating factor of MPS.

In laymen terms, MPS and Fibromyalgia formerly known as fibrositis, is defined as a long-term, body-wide pain in muscles, ligaments and tendons.

Trigger Points and Symptoms

There are a vast series of factors that can cause these trigger points to occur. The most important amongst these are:

• Muscle strain due to over activity
• Sudden trauma to musculoskeletal tissues
• Repetitive motions, excessive exercise
• Injury to intervertebral discs
• Hormonal changes (during PMS/menopause)
• Systemic conditions, such as gall bladder inflammation, heart attack, appendicitis, stomach irritation
• Nervous tension or stress
• Lack of activity
• Nutritional deficiencies
• Chilling of areas of the body

Some of the most prominent symptoms of Fibromyalgia include:

• Multiple tender areas on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows and knees
• Chronic facial muscle pain or aching
• Sleep disturbances
• Reduced exercise tolerance
• Body aches
• Fatigue

Botox – The Basics

Botox is basically a drug made from a toxin produced by the bacterium Clostridium botulinum. This toxin is well-known for causing life-threatening type of food poisoning called botulism.

Botox and Dysport are both the trade names of Botulinum toxin, the neurotoxin protein that produces the bacterium. The botox injections are a popular non-surgical treatment used for cosmetic as well as therapeutic purposes.

These injections work mainly by weakening or paralyzing certain muscles or by blocking certain nerves.

The botox injections are commonly used for:

• Temporary removal of facial wrinkles
• Severe underarm sweating
• Cervical dystonia, a neurological disorder that causes severe neck pain and shoulder muscle contractions
• Blepharospasm (uncontrollable blinking)
• Strabismus (misaligned eyes)

Botox and Myofascial Pain Syndrome

The Myofascial Pain Syndrome is typically characterized by the presence of trigger points that are subject to treatment through the injections of small doses of the Botulinum toxin type A (BTX-A). These produce prolonged muscle relaxation and can be easily targeted at the affected muscles.

A vast number of research reports advocate the use of BTX-A injections in the treatment of the Myofascial Pain Syndrome and Fibromyalgia.

A study was conducted by the Pain Evaluation & Treatment Centre in Tulsa for the purpose. 70 percent of patients with MPS in the back and extremities who received the BTX-A injections over a two year period reported a remarkable pain relief for 2.5 to 3.6 months. The patients were even able to support a therapeutic exercise regimen along with.

Other findings of various studies related to the Myofascial Pain Syndrome being treated with botox include:

1. BTX-A injections work very well with the low back myofascial pain in cases where other conventional therapies have failed.
2. The results and efficacy of BTX-A are superior and longer lasting than the conventional steroid therapy.
3. BTX-A woks better than lidocaine in the treatment of myofasical pain.
4. In a study conducted with the patients of Fibromyalgia in South Africa, several participants who received multiple and repetitive botox injections showed considerable improvement.

Special Considerations

For patients who decide to take on the botox injections for relief from the symptoms of myofascial pain syndrome, it is important to keep in the mind the below listed special considerations.

• It takes time for the results to show. It may take from 1-3 weeks for the impact to be visible.
• Frequent injections may lead to an immunity to the medicine, which can be harmful.
• There is also a risk of the development of eyelid drooping, bruising, jaw weakness, headache, neck or back pain and back weakness.
• The drug is also quite expensive and needs to be administered only by a trained specialist.

Conclusion

The use of botox injections in the treatment of Myofascial Pain Syndrome and Fibromyalgia requires further research and study to be firmly established. Latest reports in the media and internet are providing a great impetus to the treatment as a miraculous cure for the conditions. However, even though the botox injections can be helpful in treating muscle pain associated with Fibromyalgia, they do not seem to offer any cure for other symptoms of the disorder.

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Fibromyalgia Case Reports and Information Sources

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