Botulinum toxin and pain management controversy

Botulinum toxin and pain management controversy homework help


Botulinum toxin is a drug that is produced by Clostridium botulinum a gram-positive anaerobic bacterium. This same type of toxin can also cause botulism in the digestive system from ingestion of contaminated food or an infected wound.

Botulinum toxin and pain management controversy

Botulinum toxin and pain management controversy

The mechanism of action of botulinum toxin is essentially blocking neuromuscular transmission.  This is achieved through binding and entering sites on nerve terminals on sympathetic or motor neurons and inhibiting acetylcholine docking and release from vesicles.

After injection into the muscle, partial denervation occurs, hence reducing muscle movements in that area. As the body develops new axons leading to reinnervation of the muscle, these processes can be reversed.

Botulinum toxin pain management


Botulinum toxin is used in small doses for a variety of medical conditions including pain management. The pain relief achieved from the use of botulinum toxin is believed to have been a result of the secondary effects of muscle paralysis improved blood flow, the release of muscle fibers under compression by abnormally contracting muscles, and also the effects of the toxin on nociceptive neurons or pain receptors.

Conditions treated using botulinum toxin

Botulinum toxin is considered for pain management when patients do not respond to other pain management methods such as analgesics, physical therapy, or exercises and resting.

Some of the painful conditions treated with botulinum toxins include:

  • Tennis elbow
  • Chronic anal fissure
  • Facial pain
  • Myofascial pain
  • Neuromuscular disorders
  • Piriformis syndrome
  • Headaches which include migraines, tension, and carcinogenic
  • Low back pain
  • Temporomandibular joint syndrome is commonly known as TMJ
  • Pain related to mastectomy and hemorrhoidectomy
  • Whiplash
  • Painful areas in muscles
  • Chronic prostatic pain

Unapproved uses of botulinum toxin injection include:

  • Alopecia
  • Syshidrotic eczema which normally affects the palms of the hands and soles of the feet
  • Sialorrhea trusted source which involves too much saliva in the mouth
  • Psoriasis
  • Anismus is a dysfunction of the anal muscle
  • Post-herpetic neuralgia
  • Achalasia an issue with the throat that makes swallowing difficult
  • Vulvodynia, pain, and discomfort in the vagina without a clear cause
  • Raynaud’s disease which affects circulation

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How does botulinum toxin work?

Botulinum toxin normally works by binding to the nerve-muscle junction, thereby blocking the nerves that cause muscle contraction. The muscle then relaxes hence responding to nerve stimulation. This kind of effect usually takes place two to four weeks after the injection. The nerve is the ability to stimulate the muscle again within two months or so. The effect of botulinum toxin treatment on pain can last much longer even a year or more.

What do botulinum toxin injections treat?


Botulinum toxin injections are also used in cosmetics to improve appearance. Medical botox injections treat health injections are used to treat health problems which include:

  • Excessive muscle contractions
  • Crossed eyes (strabismus)
  • Eyelid twitching
  • Excessive sweating
  • Overactive bladder
  • Wrinkles and other skin aging signs
  • Pediatric upper limb spasticity
  • Cervical dystonia
  • Blepharospasm
  • Chronic migraines
  • Pediatric upper limb spasticity

 Examples of botulinum toxin products and their use in pain management

The following includes the example of botulinum toxin products along with their approved medical uses:

  • Ona botulinum toxin A (Botox cosmetics)

It is used in the treatment of cervical dystonia, severe primary axillary hyperhidrosis

crossed eyes (strabismus), and eyelid twitching(blepharospasm). It is also used to treat moderate to severe glabellar lines (forehead furrows).

  • Abo Botulinum toxin A (Dysport) is used to treat cervical dystonia and moderate to severe glabellar lines in adults.
  • Inco botulinum A (Xeomin) is used to treat blepharospasm and cervical dystonia.
  • Rimabotulinumtoxin B (monobloc) is used to treat cervical dystonia

Side effects of botulinum toxin

They can be divided into common and adverse side effects:

Common side effects

  • Swelling or bruising at the injection site
  • Headache
  • Flu-like symptoms
  • Excessive tearing
  • Crooked smile
  • Droopy eyelids
  • Dry eyes
  • Cockeyed eyebrows

Adverse side effects


It is important to call your doctor once you experience any of these side effects after several hours or weeks after an injection:

  • Loss of bladder control
  • Hoarse voice or trouble swallowing or talking
  • Unusual or severe muscle weakness especially in the area that was injected
  • Drooping eyebrows or eyelids, irritated eyes or eyes that are more sensitive to light
  • Changes in vision, eye pain or pain spreading to the jaw or shoulder, irregular heartbeats
  • Pain or burning sensation when you urinate or you may have trouble emptying your bladder
  • Cough, sore throat, chest tightness, shortness of breath
  • Crusting or drainage from the eyes, eyelid swelling, vision problems


Benefits of botulinum toxin pain management

Botulinum toxin injection helps to greatly reduce muscle spasms when injected into the muscle and also reduces pain. This treatment is not curative but repeated doses can be given. Botulinum is a local treatment which means that the injection is administered directly to the area of pain. Due to this, patients can avoid the side effects associated with systemic treatments like the fatigue that is normally associated with oral medications.

Other benefits include:

  • Reduced pain and discomfort
  • Reduced physical deformity
  • Reduced risk of contracture
  • Increased range of mobility
  • Increased range of movement
  • Increased confidentiality
  • Increased quality of life
  • Increased limb functionality
  • Facilitates efficient maintenance of hygiene and toileting
  • Reduced need for muscle lengthening surgery

How are botulinum toxin injections performed?

The physician uses a fine needle to inject small amounts of botulinum toxins into the treatment area. You may receive several injections in different spots depending on the problem. This is what you need to know about the procedure:

  • Discomfort- botulinum injections may sting and feel uncomfortable but the procedure is done quickly. Some of the providers apply a numbing agent on the skin before giving injections.
  • Anesthesia- you may receive local or regional anesthesia if you are receiving injections for an overactive bladder.
  • Outpatient procedure- treatment with botulinum injections is normally an outpatient procedure. You go home the same day you are given the injection

Risks associated with botulinum toxin for managing pain

Botulinum toxin injections are always issued under the close supervision of doctors to reduce the risk of side effects. This is a safe procedure, however, as with any treatment, there is always a small risk of complications associated with it. The following are the risks associated with botulinum toxin:

  • Bruising at the area of the injection
  • An allergic reaction to the Botox substance
  • Swelling and tenderness at the area of injection
  • Dry eyes after cosmetic uses
  • An upset stomach
  • Numbness
  • Headache
  • Mild pain, or swelling around the injection site
  • Temporary eye drooping
  • Worsening of neuromuscular disorders
  • Spatial disorientation or double vision after injection
  • cardiovascular events like myocardial infarction
  • Urinary problems after treatment for urinary incontinence

Uses of botulinum toxin injection

Botulinum toxin injections are used in small doses to treat health problems including:

  • Used to temporarily smoothen facial wrinkles and improve the appearance
  • Used to control severe underarm sweating
  • cervical dystonia- which is a neurological disorder that causes severe neck and shoulder muscle contractions
  • Chronic migraines
  • Strabismus or misaligned eyes
  • Blepharospasm uncontrollable blinking
  • Overactive bladder
  • Lazy eye- lazy eye is caused by an imbalance in the muscles responsible for positioning the eye
  • Cervical dystonia- a condition in which the neck muscles contract involuntarily causing the head to turn or twist or turn into an uncomfortable position
  • Muscle contractures- are neurological conditions like cerebral palsy, causing the limbs to pull in toward your center.
  • Bladder dysfunction- Botox injections can also help reduce urinary incontinence caused by an overactive bladder
  • Eye twitching- Botox injections can help relieve the twitching of eye muscles

Cosmetic uses:

In cosmetic surgery, Botox injections are the most popular cosmetic procedure. The effects of Botox are temporary and last 3 to 12 months depending on the type of treatment. It is normally used in the following areas of the face to get rid of wrinkles:

  • Wrinkles around the eyes also known as cow’s feet
  • Wrinkles between the eyebrows called glabellar lines or elevens
  • Cobblestone on the skin on the chin
  • Lines at the corners of the mouth
  • Horizontal creases in the forehead

Types of Botox treatment for cosmetic purposes

The various types of Botox treatments include the following:

  • Baby Botox

For younger patients, Botox helps to prevent wrinkles or slow down the progression of fine lines around the eyes, the forehead, and around the eyes. Baby Botox is a terminology used to refer to the desire for subtle rather than drastic changes, in baby Botox, the doctor injects smaller amounts of Botox. This treatment reflects the ongoing trend toward broadening the market to offer smaller more subtle changes to a larger pool of interested patients. Botox treatment can also be used to affect the balance of muscles by lifting the brows shaping and contouring them. In younger patients, Botox is used to affect the balance of muscles.

  • BlowTox- for stopping scalp sweating

Botox help with the sweating scalp. Botox can be injected into the scalp to prevent sweating. Excessive sweating on the scalp is a medical condition called hyperhidrosis. When the scalp sweats during exercise or hot weather, the hair can fall off. Women who often blow dry their hair Botox can be attractive to them. Botox injection can be given to the scalp to help the blow dry last longer. Botox reduces both scalp sweating and oil production.

It also helps to reduce excessive underarm sweating called hyperhidrosis. Botox injection blocks the chemical messenger that triggers sweat glands. By reducing the oil and sweat in the scalp, the hair does not get bogged down with grease and wetness. Botox treatments can therefore be expensive because a lot of Botox is needed to cover such a large area. The results of using Botox treatment for scalp treatment can last up to three or five months so you will need four to five treatments per year.

  • BroTox- it is for guys who want to get in the anti-wrinkle treatment

Botulinum treatment is for men as well, especially those who need the anti-wrinkle treatment. The most non-surgical procedure for men is Botox fillers. The most targeted area in men is the elevens. Most of the men have deep frown lines on their brows and when the lines are deep, it makes a person look older or even angry. Most of the men get Botox in both the crow’s feet and frown lines areas as well. This can have the result of lifting droopy brows hence making someone appear more awake and even looking less serious.

  • NewTox (Jeuveau): it is best for Ex-Botox users

It is normally used for the treatment of moderate to severe glabellar lines which are the lines that form between the brows. This treatment is still new although experts are cautiously optimistic about its effectiveness. Juneau is almost identical to Botox it seems to work very well for most people. Long-time users of Botox often find that they become resistant to it over time.

Some even say that Botox used to work well for them years ago, they are therefore advised by their doctors on whether to switch to Jeuveau or not. Juneau is thought to work quickly and the people using it see a marked difference in aesthetic improvements during the first post-treatment visit on day two, compared with the placebo group.

  • Budget B- it is said to be a dangerous cosmetic trend to avoid

This is a disturbing trend whereby people are learning how to inject the Botox toxin into their faces through online videos. Prospective patients usually buy unregulated Botox kits online, download Botox injection maps, and watch Botox YouTube tutorials on the internet.

More worrisome is that people know what they are doing is not safe but they are justifying that risk with an explanation that they have rights over their bodies and decisions. This is not safe at all. Botulinum toxin procedures are normally done by properly trained and experienced doctors. In most cases, Botox formulations bought online are counterfeit and may even be contaminated.

Injecting them into the face may look easy but injecting them requires in-depth medical experience and knowledge of how the body works. For your health safety and of course best outcome it is best to seek an appropriately trained and licensed physician. It is good to try and find out if the person in a position to perform the procedure on you is legit. You need to take advantage of the free ‘is my doctor board-certified/’ search tool provided

Exposure and transmission of botulism

Botulism transmission occurs in the following ways:

  • Foodborne botulism

C Botulinum is an aerobic bacterium which means it only grows in absence of oxygen. C Botulinum then grows and produces toxins in food before consumption. It also produces spores that exist widely in the environment including soil, seawater, rivers, etc. The formation of toxins and the growth of bacteria occur in products with low oxygen content and certain combinations of storage temperatures and preservative parameters. Botulinum toxin has been found in a variety of foods including low-acid foods vegetables, green beans, spinach, mushrooms, beets, fish, meat products, sausages, etc. Ready-to-eat foods in low oxygen packaging are more frequently involved in cases of foodborne botulism.

  • Infant botulism

It occurs mostly in infants who are six months and below. This occurs when infants ingest Botulinum spores usually germinate into bacteria that stay in the gut hence releasing toxins. This does not happen in adults or children older than six months because natural defenses in the intestines prevent germination and growth of the bacterium. Symptoms of C. Botulism in infants include loss of appetite, constipation, weakness, altered cry, loss of head control, etc. parents and caregivers are therefore warned not to feed honey to infants until one year of age.

  • Wound botulism

It is a rare case that occurs when the spores get into an open wound and start to reproduce in an anaerobic environment. The symptoms are similar to those of foodborne botulism but may have an incubation period of up to two weeks before they appear. This disease has also been associated with substance abuse, especially when injecting black tar heroin.

  • Inhalation botulism

It is rare and doe not occur naturally. It is mostly associated with accidental or intentional events such as bioterrorism which then result in the release of toxins, particularly in aerosols. Inhalation botulism portrays the same clinical footprints as foodborne botulism. After inhaling the toxin symptoms appear between one to three days normally with longer onset times for lower levels of intoxication. The patient, therefore, needs to shower and be decontaminated immediately.


Botulinum toxin injection can be used safely in the treatment of chronic pain where complications from other drug treatment is a concern. The cost of botulinum toxin treatment can be expensive although it has the advantage that there are fewer complications involved and also hospitalization is unnecessary over a short period. Botulinum toxin injection treatment effect can be maintained for 3 to 4 months while supplementary medications are reduced.

Research is, therefore, necessary on the exact treatment mechanism of botulinum toxin for chronic pain including its role in multifactorial treatment. Future research also needs to include the domain of treatable diseases, formation of antibodies, the cost, injection intervals, and complications which include muscle weakness.

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Botulinum toxin and pain management controversy

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