Botox for Pain relief

Botox A block  releases of acetylcholine from the neuromuscular  junction. The  heavy chain portion of the neurotoxin binds  selectively to  presynaptic  cholinergic motor neuron end-plates. The  Neurotoxin-receptor complex  is then  internalized by endocytosis. Internalization  is energy dependent, and  although it does not require nerve  stimulation,uptake  might be enhanced by it. It is  the basis for the recommendation  for post injection exercise  and /or  electrical  stimulation of Botox treated musculature.

Myofascial pain syndrome  is defined by the trigger  point, a hyperirritable  locus within  a taut  band of skeletal muscles, in close association  with motor   endplates of nerves. Myofascial  trigger points are characterized as latent , only painful upon  compression,  or active , constant painful  or spontaneousely  painful  with movement.  They  refer  pain in characteristic  patterns, distant from the site. The  twitch  response  is also a hall mark of myofascial pain syndrome, abrisk contraction  elicited by a snapping   palpation or introduction of a needle  into the taut band. Tigger points are assoiciated  with localized  autonomic  signs, such as  vasocontriction and pilomotor  reactions. Myofascial pain is a regional  disorder commomly affecting  cervicothoracic and /or  plevicfemoral  muscles. Tranditional trigger point injection is using  local aesthesia or /and  antiinflammatory, such as steroid to  relieve trigger point.  Trigger  point injections should be limited  to a series of 3 to 4  in patient who  derive only  temporary benefit  from the procedure.  Botox  is  considered  for  treatment of  refractory  myofascial pain syndrome, such as  whiplash, chronic  tension  headache, pirifomus syndrome and post surgical  pain  syndrome:  fail back syndrome.
 
As addition, Botox   alos has been used off -label for the treatment of  a variety of pain  syndromes, including  following conditions:
   Anal fissure
  Cervical dystonia
  Cervicogenic Headache
  Chronic  paroxysmal  hericrania
  Chronic  prostatic pain
  Cluster headache
  Reflex  sympathetic dystrophy
  Fibromyalgia
  Headache
  Interstitial cystitis
  Low back Pain/ persistant LBP  postsurgerical patients
  Migraine headache
  Muscle  tension headache
  Myofascial pain syndrome
  Pericranial pain syndrome
  Peripheral Neuropathy
  Phantom pain  syndrome
  Posttherpetic Neuralgia
  Pyriformis  syndrome
  Severe tingling causing  by heriation of cervical  vertebrae
  Temporomandibular disorders
  Trigeminal  Neuralgia
  Whiplash
-- A recent report from  Yale University School of Medicine and Walter  Reed  Medical Center  indicates that  54% patients  have derived benefit  ( at  3 weeks and 2 months) after first botox  injection . Initial responders  continued to respond  to subsequent  Botox  treatment of paraspinal muscles.
--side effers were transient and uncommon.
--Most of patients were treated  with intramuscular injection of  botox into the lumber paravertebral muscles  ( 200 units on  their symtomatic side, 100 units at their  less symptomatic side)
-- Clinical effects correspond to the drgree of  neuromuscular blockage achieved, and  typical  onset  within 24-72 hours of adminstration. Although peak effects are observed by  two  weeks  post -injection,  benefit of Pain  relief continued for patients who received botox  in several weeks as muscles relengthen and  normal machanics are restored. Chemical  neurolysis stimulates collateral axonal  sprouting and expansion  of the endplate at the enuromuscular  junction such  that contractions begin  to recur. 
--- There were no  significant  side effect.