• Dr. Naureen Akhtar General Practitioner MBBS,MRCGP,DRCOG
Botox for chronic refractory low back pain

Low back pain is one of the leading causes of physician’s visit in the UK, next to respiratory tract infection. It is a major health issue that challenges many physician, particularly since the withdrawal on a number of Cox 2 inhibitors from the market because of intolerable side effects.

Studies continue to prove the benefits of Botox treatment for muscle pain issues. Recently, it has been shown to provide a continuous reduction in refractory low back pain in more than 50 percent of patients.

Analgesic Functions of Botox

Numerous studies of human subjects had revealed that treating neck muscles with Botox can significantly decrease neck pain. Based on the data, here are the analgesic effects of Botox:

1. Reduce muscle spasm by blocking the release of acetylcholine from pre-synaptic vesicles.
2. Decrease release of pain neurotransmitter such as bradykinin and substance P from the dorsal root ganglia
3. Decrease release of sympathetic neurons or interrupt the action of sympathetic nervous system in maintaining chronic pain
4. Reduce muscle spindle discharge, which results to reduced central sensitization.

Studies on Botox for Chronic Refractory Low Back Pain

The following studies discuss the experience using Botox for chronic refractory low back pain. The two studies indicate pain relief in about 50 percent of patients who undergone treatment with this protocol.

A randomized, double blind, placebo-controlled study was conducted between 1998 and 2000 among 31 adult patients diagnosed with chronic, unilateral low back pain. Prior to the treatment, each patient was assessed for level of pain and the effect of activities of daily living on their pain using Visual Analog Scale (VAS) and Oswestry Low Back Pain Questionnaire (OLBPQ).

Result of the study indicate that at two months, 60 percent of the patients in the Botox group experience significant reduction of pain intensity compared to 18.8 percent in the placebo (saline) group. Activities of daily living also improved – 66 percent for the Botox group and 18.8 percent for the placebo. No side effects were reported.

The second study started in 2002. Seventy-five patients were assessed for chronic low back pain. After one month, 39 of the 75 patients had a significant response. Of the 39 who responded, 33 completed the 1 year follow up.

Conclusion

Treatment with Botox for chronic refractory low back pain has been shown to relieve in about half of the subjects. The side effects reported, which is flu-like symptom for 2 to 5 days, are mild and transient. The success of the two studies may be entirely due to effective methodology, covering the entire low back area and the use of adequate dose for each site to ensure maximal effect.

Currently, Botox for chronic refractory low back pain is off-label and is not approved by FDA. Because of the high cost of Botox, the approach should only be reserved for patients with refractory pain and must only be done by physicians with substantial experience and skin in using Botox for pain syndromes.