Paravertebral spasms are involuntary contractions that occur along the back when the back’s muscles or ligaments are injured or irritated. Specific movements tend to aggravate the pain and the muscle injury may cause paravertebral spasms.
Muscle spasms can also occur without muscle injury, as a natural reflex from irritated deeper structures, including torn ligaments, infections, hernia or tumours. Posture is important in diagnosing whether the muscle spasm is caused by an underlying disease.
The cause of the muscle spasm lies in the fact that the bulging disc is pressing against the ligament that holds it in place. Since this ligament contains nerves, the result is pain. Because of the initial pain, the back muscles go into spasm as part of the body’s effort to immobilise the painful area. Rather than improving matters, the result is more pain.
Botox (Botulinum Toxin A)
Patients that have easily identifiable trigger points, permanently contracted muscles, or headaches that are associated with muscle spasms are very good candidates for Botulinum Toxin A injections. Botox is the industry name for Botulinum toxin type A, which is derived from a strain of bacteria called Clostridium Botulinum. When Botox is injected into a muscle, it blocks the signals sent from the brain which tell the muscle to contract. Botox targets the muscles involved by effectively disarming them and ensuring that they do not send panic signals throughout the body. The body believes that there is no pain being experienced. Botox can help to keep the muscle relaxed for anywhere from three to six months, after which it is hoped that the muscle will be able to contract normally without pain or spasms.
Botox injections are performed as an outpatient procedure at the London Pain Clinic, with patients free to leave as soon as the treatment has been administered. Initially, the treating doctor will spend time identifying the individual trigger points, sometimes with the help of a physiotherapist, and will mark the areas with a pen. The located areas will then be sterilised with a chlorhexidine antiseptic spray and a fast acting local anaesthetic will be will injected through a small cosmetic needle.
The Botox can then be administered by one of three different ways, depending on the case. Usually, small cosmetic needles are preferred, but a Stimuplex nerve stimulator or ultrasound guidance are sometimes necessary if the trigger points are more difficult to access. 100 units of Botox are usually administered, but this can increase up to 200 units depending on the affected area.
One of the major advantages of Botox is that there is little or no recovery time, and most people feel fine and can return to their normal life immediately. The results of treatment should last around 3-6 months and the procedure can be repeated after this time.