We've all heard a lot about Botox, botulinum Toxin Type A (BoNTA). It seems as if it's being used for something different every day. There are both cosmetic and medical applications for it. In the right hands, Botox is very helpful; in the wrong hands, it can be disastrous. If you're considering Botox treatments, don't hesitate to ask how much experience your doctor has with Botox administration.
Research into the most effective ways to use Botox for headache and Migraine treatment continues and is promising. Here, we'll take a look at research performed by John Claude Krusz, Ph.D., M.D., and William R. Knoderer, D.D.S., M.D., in Dallas. Please note that this research is based on intradermal (into the skin) administration of Botox. What you're probably used to reading and hearing about is intramuscular (into the muscle) administration of Botox.
Abstract
Introduction:
It is known that botulinum toxin, type A, (BoNTA) often has marked effects on head pain and other pain. These can outlast effects on motor nerve fibers, and the mechanism may be an effect on nociceptive sensory afferent or non-cholinergic fibers. Intradermal administration was chosen to test this hypothesis for multiple types of painful conditions on the basis that nociceptive fibers are most numerous in the skin and that cutaneous sensory input contribute to these common painful conditions.
Method:
37 patients were selected with a variety of painful conditions (painful neck spasm, CRPS, type 1 diabetic neuropathy, carpal tunnel syndrome, temperomandibular joint disorder (TMJ) and trigeminal neuralgia). 50 or 100units of intradermal BoNTA was administered. 15 patients had co-existent Migraines. All head pain patients had painful cervical muscle spasm, evidenced by examination. BoNTA was given intradermally by raising a skin wheal at the site of pain on the side of predominant pain symptoms.
Results:
All 37 patients had pain reduction with intradermal Botox. Neck pain (n=14) was 85% diminished. Back pain (n=4) responded in 2 cases, to an extent of 40%. CPRS, type 1, (n=5) resulted in a response of 90%, particularly for the burning symptoms. Diabetic neuropathy (n=2) had an excellent response. Carpal tunnel syndrome (n=5) saw all patients respond. TMJ (n=5) all responded, as did 2 patients with trigeminal neuralgia. Some patients had more than one painful disorder. Average pain reduction across all categories was 68% with average duration of 9.5 weeks (range 3-20). 26 patients (74%) reported virtual eradication of pain, and in particular, that of burning pain. All patients reported relief of painful cervical spasm, even when headache pattern did not change.
Conclusions:
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Botulinum toxin, type A, given intradermally, shows a marked ability to reduce painful symptoms in many different pain states, some not studied clinically.
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It also has excellent efficacy in treating painful cervical spasm.
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These results compare very favorably, or are better than, results from usual intramuscular administration of Botox.
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This open-label data raises many questions about mechanism(s) of action of Botox, particularly in the central nervous system, including uptake into nociceptive fibers and transport to the dorsal horn of the spinal cord. Blockade of pain transmission at central facilitative sites may occur, and this, in turn, reduces pain transmission in various pain states.
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Double-blind studies are definitely warranted to replicate these findings.
Summary:
This is very promising research
for anyone with headaches, Migraine, or any of the other conditions treated in
this trial. Intradermal administration of Botox is less painful than
intramuscular and, in this study, compared quite well with the intramuscular
administration. We should be seeing results of double-blind studies on this application in
the near future.
>> For more details on this research and to view the poster presentation referenced below, click HERE.<<
Resources:
Krusz, John Claude, Ph.D., M.D.;
Knoderer, William R., D.D.S., M.D. "Intradermal Botulinum Toxin Type A: To
Treat Pain Disorders." Poster
presentation to the annual conference of the American Pain Society,
Boston, March,
2005; and to the European Federation of Neurological Societies conference,
Athens, Greece, September, 2005.
Article published November 21, 2005
