Botox for Neck and Back Pain

A nurse holds a needle.
Nerve blocks are spinal injections. H. Armstrong Roberts/ClassicStock Archive Photos/Getty Images

Although Botox is best known as a wrinkle smoother, it has also started to gain steam for a number of other purposes, including migraines, overactive bladder, certain eye conditions, excessive sweating, and neck and back pain relief.

Can Botox Get Rid of Your Neck or Back Problem?

When injected into neck or back muscles, Botox works its reported magic by blocking a neurotransmitter compound known as acetylcholine; this has the effect of rendering muscles and/or glands inactive, according to an evidenced based review published in the February 2013 issue of the Journal of the Royal Society of Medicine.

Note that Botox, in this case, is not intended as a cure, either, but rather to serve as a temporary pain relief measure.

The question is, can Botox really relieve your muscle related pain? And if so, which type — neck, back, or both?

For muscle related spine pain, the short answer is, don't get your hopes up.

The authors of the review mentioned above researched other reviews on the medical uses of Botox, and found that in general, physicians tend not to recommend this use of the drug as a chronic pain treatment to other physicians. 

One reason for this may be that pain relief from Botox injections seem to be on par with the amount of pain relief that can be had with injections of saline solutions, according to a 2011 Cochrane* Database System Review>

In other words, not much relief can be had from a Botox injection into your muscles. The Cochrane researchers found good evidence that Botox is ineffective at relieving neck pain or improving functioning.

Botox for low back pain had received similar ratings with one important exception: Even fewer studies have been done to determine its effectiveness at relieving pain or improving your physical functioning. 

And a 2014 Cochrane review found inconclusive evidence for the use of Botox in cases of myofascial pain syndrome and trigger points.

Botox for Your Nerves

There are two types of Botox — Botulinum toxin A, and Botulinum toxin B. For spine pain caused by tight or stiff muscles, Botulinum toxin A is generally used.

In recent years, both the A and B types have been studied for nerve related pain. A 2017 review found evidence for the use of Botulinum toxin A in cases of postherpetic neuralgia, trigeminal neuralgia, and neuropathic pain brought on by spinal cord injury.

The same review suggests that Botulinum toxin B may be helpful in cases of diabetic neuropathy, pain related to stroke and neuralgia following surgery,

Botox Treatment for Wry Neck, or Cervical Dystonia

But one neck condition that does seem to respond to Botox treatment is cervical dystonia, (Other names for cervical dystonia include spasmodic torticollis and wry neck.)

Cervical dystonia is a condition in which neck muscles remain in constant contraction. Not only does wry neck cause neck pain, but it also leads to twisted and/or other awkward neck positions that are very difficult to release.

The Royal Society of Medicine review mentioned at the start of this article found that a single injection of Botox is effective and can be safely repeated if necessary. The authors say that Botox not only reduces abnormal movements and contractures associated with these conditions, but it also can prevent related spinal degeneration and radiculopathy.

The Tox in Botox

Botox's full name, which is, Botulinum toxin, gives us a clue about it's nature. It is a poison that can paralyze nerves, but may also possess some healing powers. An 2016 article published in the Indian Journal of Dermatology, calls the drug "the miracle poison."

But in the hands of the wrong health practitioner, or, illegally, the wrong lay person, Botulinum Toxin can have devastating effects on the nervous system. Until it is properly diluted and prepared, it remains poisonous. 

*Note: Since 2007, the author of this article has served as a consumer reviewer for the Cochrane Back Group.

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