Botulinum Toxin (Botox)
Botulinum toxin is produced by the anaerobic bacterium Clostridium botulinum, a rod-shaped, gram-positive organism found in soil and water. This toxin is responsible for botulism, a condition associated with food poisoning or wound infections where the toxin affects the release of chemicals required for muscle contraction from the nerve endings onto the muscles. This is obviously very dangerous, but careful local injection of the purified neurotoxin can be therapeutic in some conditions. People are probably chiefly aware of the use of this in cosmetic treatments, but it can also be very useful in the management of spasm and muscle contractures in cerebral palsy and other conditions and in the treatment of squint and some other conditions associated with abnormal muscle contraction. There is evidence that, as well as working on the nerve endings in the muscles, botulinum toxin can have effects on the nerves carrying pain sensation.
The use of botulinum toxin in pain management is the subject of some controversy. Some clinicians use it in the treatment of myofascial pain by injection into trigger points. Recently its use has been suggested as one of the options in treatment of migraine.
A useful series of pages (which, while written for medical professionals, is very comprehensible) on the medical use of botulinum toxin in pain management is at the emedicine site.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 19/02/2016