Some more on Botox/Myobloc from WSJ.
Wrinkle-Fighter Is Being Used
To Treat a Variety of Ailments
A popular remedy for wrinkles and frown lines now is being used to relieve backaches, migraines and chronic pain.
Dermatologists and plastic surgeons have used Botox for years, although formal Food and Drug Administration approval for cosmetic use isn't expected until next month. The drug is a form of botulinum toxin, made from the bacteria that cause botulism, a deadly illness that essentially paralyzes the muscles that control breathing. But the toxin also can be harnessed to temporarily paralyze and relax facial muscles that cause wrinkles.
Now, doctors are learning that Botox can be used to treat chronic pain, although that use also isn't approved by the FDA.
Amy Lang, associate professor of physical medicine and rehabilitation at Emory University in Atlanta, says about 80% of her patients being treated with Botox have responded. She uses it for chronic back, neck and headache pain.
Not every patient is a candidate. For Botox to work, the pain must be related to a muscle that has seized up or is so taut it is contributing to the problem. The Botox injection partially paralyzes and relaxes the muscle, breaking the cycle of pain.
Side effects of botulinum toxin injections can include pain at the injection site and nausea. Sometimes, it can cause muscle weakness or a heaviness that usually subsides in a few weeks.
Rarely, patients can develop antibodies to the drug that render future treatments ineffective. Some patients simply don't respond to Botox, although it isn't clear why. Those patients may get relief with another version of botulinum toxin, Myobloc, from Irish drug company Elan.
Although many doctors and patients swear by the injections, insurance companies don't always pay for them. It can get expensive. A single vial of Botox costs about $500, and patients often need two vials per treatment. Add in the cost of the doctor's time and the cost of the procedure itself, and patients face a $1,000 to $1,500 bill for a treatment that lasts three to six months.
Some insurance companies, however, are beginning to reimburse doctors who use Botox for pain. "The companies that are smart pay for it because it can get people out of the medical office," Dr. Lang says. "They end up getting less medical treatment."
Stephen Silberstein, professor of neurology at Thomas Jefferson University and director of the Jefferson Headache Center, both in Philadelphia, has been studying Botox in the treatment of migraine and headache. Dr. Silberstein, whose research has been funded by Botox maker Allergan, of Irvine, Calif., says about half the patients respond to the treatment.
While the site of the treatment injections varies, he often chooses the "tender spots" that most chronic headache patients have even when they don't have a headache. Other potential injection sites include the forehead muscle between the nose, the jaw muscle and the muscles at the back of the head.
Although the injection is expensive, Dr. Silberstein thinks it's preferable to daily medication, which also is costly and often carries more severe side effects. "Pricewise, I really think it's a wash," he says.
Sheldon Simon, chief of pediatric orthopedics for Beth Israel Hospital in New York, uses the toxin to treat children and adults with cerebral palsy. The treatment can temporarily loosen spastic muscles and relieve pain.
It also is used to delay tendon-lengthening surgeries so doctors only have to perform one surgery on a child at the end of a growth spurt rather than perform several interim surgeries over several years. "Almost all the patients respond to it," Dr. Simon says.
Not every doctor is a fan of the toxin treatment. Gabriel Martinez, physical medicine and pain-management specialist at Mercy Medical Center, Baltimore, prefers to use local anesthetics such as lidocaine because they are far less expensive and are covered by health insurance.
He says that even though lidocaine wears off more quickly than the toxin, it still breaks the pain cycle and can result in lasting relief. "I find the majority of patients have effective treatment with a much less expensive medication," he says.
Manhattan anesthesiologist and pain-management specialist Alan M. Leff uses a CT scan to achieve deep-muscle injections of Botox. One of his patients, search-firm executive Arnold Huberman, says Botox treatment helped relieve his pain and postpone back surgery for a disk problem.
"I felt like a whole new person," he said. "It was extraordinarily effective."
Ifeoma Okoronkwo, clinical assistant professor at New York University School of Medicine, says it's important for people to realize that the toxin injections don't always work on every patient. In her practice, patients who are candidates for the treatment get relief about 75% of the time.
"It's not a panacea or something I would ever use in and of itself," Dr. Okoronkwo says. "But people come to my practice seeking this particular treatment now. I've never had anybody say, I wish I didn't do Botox."
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