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Botox

History

Botulinum Toxin (in its most common preparation commonly know as Botox) has a fascinating history. The toxin itself which derives from the bacteria Clostridium Botulinum (not to be confused with the agent responsible for severe diarrhoea known as Clostridium difficile) was associated with the bacterium as early as 1895. Subsequently the toxin itself was isolated by Dr Sommer at the University of California in 1920s. In 1940s Edward Schantz purified the toxin and persuaded colleagues to investigate its physiological action.

The agent was first used clinically by an ophthalmologist Dr Scott to correct hyperactivity in eye muscles in the condition known as strabismus.

In 1988 the American Company Allergan based in Irvine California obtained the right to conduct clinical trials into the drug’s efficacy for indications such as cervical dystonia.

Currently Botulinum Toxin is one of the most researched compounds known to mankind. It has over 60 recorded clinical applications including the treatment of wry neck, muscle spasm and pain. More recently exciting developments have occurred in the field of migraine prophylaxis and pain.

Currently Botox is licensed to treat the following conditions in the United Kingdom:-

Cervical dystonia – otherwise known as wry neck or torticollis causing severe muscle spasm in the neck
Strabismus – involuntary muscle spasm in the face

Unlicensed indications include the treatment of various muscle pain syndromes such as piriformis syndrome, spasticity, hyperhydrosis (sweating) and migraine.

Botox is thought to act by two distinct mechanisms. It has a direct pain killing effect (anti-nociceptive effect) as a result of blocking central transmission of pain impulses from the periphery to the brain. It also acts on muscle nerves resetting the level of contraction and thereby reducing muscle spasm.

Facts about Botox

Whilst the number of clinical indications for Botox has escalated dramatically over the last 5 years it is not a new drug or novel technique. It has been used cosmetically for around 15 years and indeed some of its beneficial effects in terms of pain alleviation were the result of a spin off from its use cosmetically. An example of this is the use of Botox in migraine prophylaxis where early indications of its potential benefit were derived from patients undergoing cosmetic treatment with Botox and noting a decrease in the frequency and severity of their migraine headaches.

The incidence of side effects or complications with Botox is incredibly small. Unlike other analgesic preparations it does not cause systemic upset, central effects such as light headedness or failure of concentration, liver or kidney toxicity. There are no reported cases of allergy and improvements in manufacturing processes have resulted in an increase in the purity of the product and hence a decrease in tolerance secondary to the formation of antibodies on repeated injections.

Other complications are exclusively related to dosage and as such it is essential that your Botox injections are performed by an individual experienced and competent in the delivery of Botulinum Toxin injections. The commonest complication associated with excessive Botox injection is weakness in the affected muscle and this may for instance cause drooping of an eyelid underlying treatment for hyperactivity of the orbital muscles or neck muscle weakness in the treatment of cervical dystonia. Occasionally patients experience a flu like illness which is self limiting and occurs approximately 2 weeks after Botox injection.

The onset of action of Botox is approximately 2 weeks after injection.

Would my condition be suitable for Botox treatment?

Currently in the UK Botox has a product licence for the treatment of cervical dystonia and various ophthalmic conditions such as strabismus or blepharospasm.

It may be given however in a number of different conditions and studies are now emerging indicating its effectiveness in the treatment of:-

Painful neck pain associated with muscle spasm
Piriformis syndrome
Complex regional pain syndrome
Lower back pain associated with muscle spasm
Migraine

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