Craig R. DuBois, M.D.
The Pain Evaluation & Treatment Center
7307 Creekbluff Drive
Austin, TX 78750
512-346-6969
http://www.paineval.net/our_physicians.nxg
Transcript: How Botox works on pain signals
Something that’s developed over the last, oh I’d say, two years or so is the introduction of a medicine called Botox in the treatment of pain. And Botox, I think most people will have heard of it, either jokingly or in reality for wrinkle treatment. And when I introduce that idea to patients they’ll say “Are you treating my wrinkles?” No, no, no. We’re not worried about the wrinkles. They may be but we’re not.
The Botox works biochemically in the cells that transmit nerve signals. The way it works for wrinkles is it slows down the transmission of the muscle contraction signals so that you know, we always joke that “Somebody can’t make their eyebrows go up when they’ve had too much Botox.” True. But if you have a little bit of Botox in those areas it also interrupts or changes the nerve transmission in some of the pain signals. And so, that’s the theory that’s been introduced to use it in pain conditions.
We initially started out using it just for muscle problems. And then we found out, hey, it did more than just take the muscle spasm down. Those people had less pain in that area as well.
Now the problem with it is: A. It’s expensive. You know, it’s like $500 for a little bottle of pixie dust and B. It doesn’t last very long so a doctor has to kind of mix it up and use it in several patients because you don’t use the whole bottle in one person.
The good news is on the average it’s very, very safe. You hear and read about some bad things that have happened but it’s generally been very, very safe. Very widely used. I think I’ve put it in every part of the body you can imagine from vocal cords to back muscles to deep muscles. It just a matter of getting it in the right place and the right dosage. And the problems we see are generally people who are either poorly trained or who don’t really think about the total dose.
But I’d encourage patients to consider it but the real factor would be cost. And right as of yet, we still have problems with getting insurance companies to cover it because there haven’t been a lot of good double blinded, standard controlled studies that they’ll accept. But on the other side of the coin, it is in a low dose, in most cases. It is affordable in low dose for most people to try even on a personal cash basis. I kind of tell people it’s a $150 gamble for instance. You know. It may cost you $150-200 to try an area. But the good news is if it doesn’t work, it rarely causes a major problem.
The good news is it wears off if you did cause you like a droopy eye from getting it in the wrong spot. The good news is it’s going to wear off.
The bad news is it’s going to wear off. After three or four months, the body mobilizes and figures out how to rework that chemistry and it wears off.
But I’ve had some people who treated in some fashion every three to four months, some going on six or eight years every three or four months. For them it works and it keeps working.