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Botox Offers New Wrinkle for Treatment

New studies show it relieves lower back pain, even sciatica

MONDAY, March 24, 2003 (HealthDayNews) -- It first made headlines as a controversial new wrinkle treatment, but it's rapidly making a statement in other areas of health care.

The treatment is Botox, and it's among one of the newest ways to treat lower back pain.

In numerous studies presented at the just-concluded American Pain Society conference in Chicago, doctors from across the United States and Europe offered new evidence that Botox can indeed work in a variety of situations to treat not only chronic lower back pain, but also sciatica and even some forms of neck discomfort.

According to rehabilitation physician Dr. Todd Schlifstein, it offers an important new option, particularly for people who may not respond to traditional care.

"It's not for everybody or for every type of pain, but when it's used appropriately, it can offer relief, even when other treatments have failed," says Schlifstein, a rehabilitation physician at New York University Medical Center who did not participate in the conference.

Botox is the brand name of a naturally occurring substance known as botulinum toxin type A. The toxin itself is related to botulism, a form of food poisoning that occurs when meat or other foods develop a bacteria known as Clostridium botulinum.

Doctors had long known that in severe cases of botulism, paralysis results. This occurs when the toxins attach to nerve endings in the body, preventing the release of brain chemicals that normally control muscle contractions.

Using this action as a basis for discovery, doctors soon learned that in controlled amounts, this same toxin could be used to manipulate brain chemistry, thus controlling contractions in patients suffering from diseases linked to severe muscle spasms, such as multiple sclerosis (MS).

However, in tests on patients with MS, doctors soon discovered something more. When Botox was injected into facial muscle spasms, wrinkles began to relax -- and seemed to disappear. Not long after, an anti-aging cosmetic treatment was born.

Soon after that, experimentation involving lower back pain began, and Schlifstein says the results are proving promising for many patients.

"If the back pain is the result of spasms deep within the muscles, used in controlled amounts Botox can offer relief lasting at least three months -- and sometimes permanently -- from a single treatment," Schlifstein says.

That's exactly what a number of studies presented at last week's pain conference found.

In the first study, researchers from the A & A Pain Institute of St. Louis treated six men and three women, aged 36 to 69, who had suffered from low back pain from three to 12 years. Each found no relief with traditional treatments, including steroid injections and physical therapy.

Using a "zero to 10" pain assessment system known as VAS (visual analog scale), each person rated their back discomfort just before receiving a one-time Botox injection. That injection ranged in strength from a high of 300 units to a low of 50 units, depending largely on the size of the muscle.

The result: The average pre-treatment VAS score as 7.3; 12 weeks after the Botox treatment, pain scores averaged 2.5. After the first week, pain was reportedly reduced by 50 percent, with additional relief coming in the following weeks.

Two of the patients had total pain relief by the second week, and they were still pain-free one year later. All nine patients experienced significant relief, but three did have some pain return after 12 weeks. None of the patients had increased pain, and there were no significant side effects.

Researchers from The Neurological Research Center in Bennington, Vt., reported a similar finding after using Botox injections on 12 patients suffering from back pain for an average of 10 years. Five had previously had surgery, and the remaining seven had tried an assortment of other treatments -- and none found any relief.

The researchers found that injecting from 100 units to 300 units of Botox into back muscles reduced pain and discomfort by 50 percent or more in all 12 patients, with no reported weakness or side effects.

In yet another study presented at last week's conference, doctors from Burnley General Hospital in England reported they had injected 100 units of Botox into 12 patients diagnosed with sciatica. This is a unique form of lower back pain causing a burning, radiating ache that frequently starts in the buttocks and travels to the thigh, knee and, sometimes, the lower leg and foot. All 12 patients also had restricted hip movement and all had failed to find relief from previous treatments.

Using three types of measurements to assess pre- and post-treatment pain (VAS, sleep and daily work activity), as well as a medical exam to check for flexibility and hip movement, the doctors reported that Botox offered significant pain relief in all 12 patients.

After a four month follow-up, five patients reported complete pain relief, while the remaining seven experienced at least a 50 percent reduction in pain. All the patients experienced increased hip movement and flexibility.

Botox is also being used to treat neck pain as well as migraine.

More information

To learn more about the healing powers of botulinum A toxin, visit the U.S. Food and Drug Administration. For more information on other new treatments being studied for back pain, click here.

SOURCES: Todd Schlifstein, M.D., associate professor, medicine at New York University Medical Center, New York City; March 20-23, 2003, presentations, American Pain Society annual conference, Chicago
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