Botox: Kill or Cure?

When I first saw Botox mentioned as an effective treatment for neuropathic pain; I had to laugh; 'What will they think of next!' Then I saw it appearing several times in lists of treatments and realised that it's no joke - people seriously consider Botox as an alternative! Then you start searching for corroborative evidence to see if there's any science behind the theory. The problem is that most of the articles on the subject are written by private clinics, or practices offering it as an alternative and like all advertising,you believe every word at your peril.

Let's look at the facts:
Botox, botulinum Toxin Type A (BoNTA):it seems as if it's being used for something different every day. There are both cosmetic and medical applications for it. In the right hands, Botox is claimed to be very helpful; in the wrong hands, it can be disastrous. If you're considering Botox treatments, don't hesitate to ask how much experience your doctor has with Botox administration.
Botox is a product of botulinum toxin, a bacterium found in food poisoning. and theoretically, works to relieve pain by blocking muscle contractions.

The first article comes from the Atlanta Medical Day Spa and Surgery Center (see link below) and here the facts are confirmed by other sites.

Scientist and researchers are still trying to understand the foundation of the biological processes that are responsible for diabetic neuropathic pain. In turn, the treatments being used now for this ailment are just not cutting it. But recent research with Botox shows evidence that suggests that botulinum toxin type A may not only stall the discharge of acetylcholine at the neuromuscular junctions, but also amend afferent sensory fiber firing, which leads to relieving neuropathic pain.

The method used for this study was a double blind crossover trial of intradermal BoNT/A for diabetic pain in 20 patients and was conducted to evaluate the effectiveness. The results were very surprising. The scientist found a significant decline in visual analog scale (VAS) of pain by 0.89 +/- 1.11 at 1 week, 2.32 +/- 2.29 at 4 weeks, 2.34 +/- 2.57 at 8 weeks, and 2.54 +/- 2.49 at 12 weeks after injection in the BoNT/A group, as compared to the relevant findings for a placebo group of 0.40 +/- 1.19, -0.12 +/- 2.03, 0.43 +/- 1.63, and 0.54 +/- 1.58 at the same time points (p < 0.06). Within the BoNT/A group, 45.5% of the people being tested experienced a drop of VAS >/=4 within 3 months after innoculation. The group who were placebo had no such affect.

To put this into layman terms, the study showed that Botox (botulinum toxin type A) significantly reduced the occurrences of diabetic neuropathic pain and also improved the patient’s ability to sleep.

http://www.atlantamedicaldayspa.com/Botox_and_Diabetic_Neuropathy.asp


A Taiwanese team led by a Dr.Chaur-Jong Hu, did the following interesting research: (see link below)

People with diabetes often suffer from chronic foot pain because of nerve damage, but relief may be at hand. Taiwanese doctors have shown that the pain can be reduced substantially by injections of botulinum toxin type A -- better known as Botox -- into the skin on top of the foot.

Dr. Chaur-Jong Hu, at Taipei Medical University, and associates tested the treatment in 18 patients with type 2 diabetes who had nerve-related pain in both feet.
The participants were randomly assigned to get injections of Botox or saline, then 12 weeks later crossed over to receive the opposite treatment.
A local anaesthetic gel was applied first, and then the injections were administered into the skin (rather than into muscles) at 12 sites across the top of the foot, the team explains in the medical journal Neurology.
At the start of the study, the average pain score on a scale of 0-10 points was 6.36. There were significant differences in the decrease in pain scores between the Botox and saline injections during each 12-week period.
Specifically, at 12 weeks, the score was reduced by 2.53 points with Botox injections compared with 0.53 points with the saline injections.
Moreover, 44 percent of the subjects had a reduction of at least 3 points in their pain score within 12 weeks after the Botox injections.
An added benefit was that patients are able to sleep much better after the treatment.

Hu's team concludes that intradermal Botox injections "are an effective and safe method of relieving diabetic neuropathic pain in the feet." However, "the detailed underlying mechanisms, optimal dosage, and precise course of therapy require further evaluation."

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=29526

And a Dr B. Gibson offered the following opinion (see link below):

Botox For Diabetic Nerve Pain – Dr Brandt R Gibson

In a recent study found in Neurology (28 April 2009), a group of scientists tested the use of injections of botulinum toxin type A—better known as Botox— into the skin on top of the foot to treat neuropathy pain. In this study, 44% were noted to have significant improvement of their pain after multiple treatments with botox. The question is whether this is a good idea.

Neuropathy pain is problematic and often difficult to treat. For years, people have been told that no treatment is available. If this were truly the case, Botox would be a good option. If it is typical Botox, however, it would require recurrent treatments throughout life to maintain the relief. And there is also a large concern for risks of injecting this substance into the skin of a diabetic without normal nerve feeling.

http://mydiabeticfoot.blogspot.com/2009/05/botox-for-diabetic-nerve-pain.html

And the following is just one of many reactions to be found in the forums; both for and against:

"I unfortunately found out the hard way about all the severe problems with botox. They use botox for a localized peripheral neuropathy since when a nerve is injured it causes severe pain but when it is completely destroyed there is no pain at all. The hopes is it will destruct the nerve more and the pain will cease. Although if it gets in your blood stream it can cause neuropathy all over your body, just check the package insert. It is the most potent neurotoxin known to man and by definition destructs nerves. I would avoid this treatment if at all possible, it could really set you up for a worse nightmare. I am living that nightmare every day for the past three years."

There seems to be enough food for thought but like everything else, the individual must make up his or her own mind about Botox. There are independent research studies popping up all over the place but larger and more verifiable studies seem to be needed.

It seems logical that the first step must be a discussion with any doctor who is both qualified in the field and is prepared to talk to you. If you can't find an independent medical opinion, it doesn't seem wise to go any further. Botox is no aspirin preparation! Even if you want to regain your lost youth and use Botox in the 'normal' way; or are using it to counter the effects of lipoatrophy, you need to be informed exactly what you're doing and what the risks are. This is a different Botox application to that used for cosmetic purposes - for a start it's injected differently - under the skin and not into the muscle. And all this doesn't take the cost into consideration - it won't be cheap! However, if it is found to be a valid treatment, it will eventually become common practise and eventually be covered by basic insurances (pigs may have long since learned to fly!!).

Having said all that, it's very unfair to let personal opinion override the facts and I think everybody will be interested in other people's experiences and ideas, so please use the Contact form or the Comment button under the post to let us know what you think.