Use of Botox in Musculoskeletal Pain Management
SEROTYPES AND MECHANISM OF ACTION Botulinum Toxin is one of the most powerful neurotoxins. It consists of a 50 kDa light chain and a 100 kDa heavy chain that is connected with a disulfide bond. Seven serotypes (A–G) have been detected. There are seven serotypes of Botulinum Toxins described to date, namely A through G. The Botulinum Toxin is observed to interfere with expression of many neuropeptides, including Subset ST and calcitonin gene-related protein (CGRP), which are main contributors to neurogenic inflammation from 16 Botulinum toxin A(BoNT/A) injection into rat cadavers had been shown to decrease paw edema in formalin treated rats, decrease tissue glutamate release and obtund spinal cord excitability. Overall, it is reported that Botulinum is a cytokine, neuropeptide, and other inflammatory mediators and its inhibitors. The proposed anti-nociceptive mechanism of action of Botulinum Toxin is further supported by, a lot of clinical studies.
APPLICATIONS
The neuromuscular blockade induced by BOTOX has demonstrated effective relief of pain and restoration of function in patients with painful, chronic musculoskeletal conditions.
OSTEOARTHRITIS
BOTOX is used more and more in the non-invasive treatment of arthritis of the knee, hip, shoulder, and other joints. Many patients demonstrated a marked response to treatment with improvement in pain scores and in quality of life. Patients of knee arthritis who were injected with BOTOX reported significant improvements, noted Moore and colleagues.
PLANTAR FASCIITIS
One of the most prevalent foot and ankle diseases seen among the population with BoNT being beneficial for refractory cases seen with failure of physical therapy and steroid injections. Year after year, the evidence of significant improvement in pain and the near lack of side effects is making it more popular among Musculoskeletal practitioners today.
MASSETER PAIN
Pain over the mastication muscles (MASSETER) – secondary over activity of the masticatory muscles responds well to intramuscular BOTOX injections. It is administered in the form of injections, usually through the oral route. The traditional recommended doses are 50 units into the masseter and 25 units injected into the temporalis. Experiments have described up to 80% of patients having everlasting ache alleviation for up to 10-12 months.
TENNIS ELBOW/ LATERAL EPICONDYLITIS
Likely the most common indication for tennis elbow, a recent publication found that BoNT-A injection was associated with decreased pain and improved functional ability. BoNT-A has temporary block features, however reduces finger movement and grip strength due to the motor effects, it is crucial to monitor the dosage and take care of the procedure.