Botox for Neck Pain
Most people will associate botox injections with the expressionless faces of numbed, washed-out celebrities desperate to reclaim their wrinkle-free youth. But botox has also been used for a number of years in the attempt to help patients cope with the neck pain that can occur in injuries such as whiplash. How effective is this treatment, and how does it work, if at all?
Indications for Botox Use
The premise behind botox’s use for whiplash associated disorder is based on the occurrence of rapid extension and then flexion of the neck musculature during the accident which can lead to aberrant muscle spasms in the cervical spine. Using systemic drugs such as oral steroids, muscle relaxants, or NSAIDs immediately after the car accident, fall, or other trauma have potential side-effects which can limit their utilization. Other therapeutic interventions involving physical manipulation, and neck exercises can be beneficial for a limited period after injury, but physical therapies such as ultrasonography, heat, ice, and acupuncture are not associated with an improved prognosis in whiplash associated disorder. They can, of course, help with many other disorders that cause neck pain, such as arthritis or muscle strain, whilst remaining inappropriate for acute whiplash related neck pain. In using botulinum toxin-A to reduce muscle spasms, patients may suffer less neck pain after whiplash and have improved scores on the QTD-WAD.
The QTD-WAD What?
The Quebec Task Force (QTF) on Whiplash Associated Disorders (WAD) uses a five level classification system to categorize the level of disability and pain experienced by patients after such an injury and it is this scale that is often used during research, such as that into botox.
- WAD 0 – no neck complaints or physical signs
- WAD I – neck complaints but no physical signs
- WAD II – neck complaints and musculoskeletal signs, such as decreased range of motion and muscle tenderness
- WAD III – neck complaints and neurological signs
- WAD IV – neck complaints and fracture or dislocation
The most common symptoms of whiplash, after a car collision, are neck pain (80-100%) and headache (54-66%) (Norris, 1983, Stovner, 1996). Patients may also experience neck stiffness, dizziness, visual and auditory symptoms, paraesthesia, pain or numbness in the arms or shoulders, and muscle weakness or loss of fine motor control in the hands. These symptoms often mirror those present in patients with disc bulging or herniation and, indeed, these can be consequences of the accident itself. In the majority of cases people who suffer WAD recover quickly, with 47% returning to normal activities within four weeks, and just 2% prevented from enjoying their normal routine a year after the accident (Spitzer, 1995).