Wonder-Poison Spells Relief for Low Back Pain

From the WebMD Archives

May 21, 2001 -- Add chronic low back pain to the growing list of conditions that tiny amounts of a deadly poison can safely relieve.

Botox, or botulism toxin, when extremely diluted can be used to temporarily paralyze and erase crow's feet and facial wrinkles, put an end to excessive sweating, curb migraine and tension headaches, help with muscle spasticity from multiple sclerosis, cerebral palsy, and stroke.

Although it's an extract of the same chemical that can cause a potentially fatal form of food poisoning called botulism, it's used medically in much lower concentrations. And that's not all; botox is also used for straightening crossed eyes and stopping uncontrolled eyelid spasms.

As if that weren't enough, now new research shows that injecting tiny amounts of this muscle/nerve paralyzer into five muscles along the spine can relax those muscles and relieve back pain by about 50% in about the majority of sufferers. Researchers don't know exactly how botox affects back pain, but they speculate it may reduce the amount and severity of muscle spasms.

These findings will be welcome news for the millions of Americans who suffer from constant, daily low back pain. Nearly 90% of adults experience back pain at some point in their lives and long-term low back pain costs about $50 billion per year in the U.S. Many sufferers will try muscle relaxants, nonsteroidal anti-inflammatory medications, antidepressants, surgeries, and even alternative approaches such as acupuncture or magnet therapy and still see no relief.

Still, the effects don't last forever. Just as wrinkles return several months after getting botox injections, back pain relief from botox tends to wear off after three to four months. In some people, however, the relief can last as long as six months.

"This seems to be a promising way to treat some patients with low back pain," researcher

Bahman Jabbari, MD, chairman of the department of neurology at Uniformed Services University in Bethesda, Md., tells WebMD. "I don't think many doctors are using botox for back pain at this point," he says.

"We don't know many back pain sufferers botox will help because this is a small study. In the future, we need to do a larger study that follows patients for a longer time," he says.

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In the new study, which appears in the May 22 issue of the journal Neurology, 31 people who had low back pain for an average of six years received injections of botox or placebo injections of a salt-water solution.

Three weeks after receiving the botox injections, more than 70% of participants said the amount of pain they felt had decreased by half. By comparison, just one quarter of those who received shots of a salt-water solution reported this much relief.

And, by the study end, at eight weeks, 60% of study participants who received botox injections still said their pain was decreased by 50%, compared with 13% of those who received placebo shots.

In addition, 67% of the patients who received botox said they were better able to perform activities of daily living such as walking, lifting, and traveling, compared with 19% who got saline injections.

"Botox has a lot of potential and has been used in many different areas," says Jabbari, also a neurologist at the Walter Reed Army Medical Center in Washington.

"Doctors have had 12 years experience with this medication and it has very little serious side effects," he says. "You don't want to inject too much and make muscles weak, but in reasonable doses it can relieve muscle pain."

Gerard A. Sava, MD, a neurological spine surgeon in Stamford, Conn. is somewhat skeptical about the use of botox in treating back pain -- at least until he sees more study results.

"It's probably more of a placebo effect," Sava tells WebMD. "There is a huge number of causes of low back pain."

When Sava sees a patient for low back pain, he starts by taking a thorough medical history. He asks how long the patient has had the pain, if they have been injured and then asks about age and general health status.

"You have to cover all the bases," he says.

There are other modes of attack. Los Angeles-based back pain specialist William Deardorff, PhD, and co-author of Back PainRemedies for Dummies recommends a multipronged approach to the treatment of low back pain.

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"If ... the spine looks fine, we educate [patients] that the pain signal they are feeling is not indicating tissue damage. We try to change how the patient thinks about pain, educate them about current theories on pain and then teach some muscle relaxation techniques," he tells WebMD.

Many people with back pain develop a fear of movement and a fear of reinjury so they put them through a reactivation/reconditioning program that combines special back exercises and cardiovascular exercises.

"We may also use antidepressants to improve sleep and relieve pain to some degree," Deardorff says.

He says that his success with this type of program is pretty good if the patient is willing to forgo their search for a quick-fix and accept this treatment model.

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