Fibromyalgia, or Fibromyalgia Pain Syndrome, is a chronic and widespread musculoskeletal pain and fatigue disorder. It is defined as a long-term, body-wide pain in muscles, ligaments and tendons – the soft fibrous tissues in the body. It is typically characterised by widespread aches and pains, restless sleep, awakening feeling tired, fatigue, anxiety, depression and disturbances of bowel function.
Unfortunately the cause of Fibromyalgia is unknown, but there are thought to be multiple factors involved. Scientific research shows that patients who suffer from the pain of fibromyalgia have changes that occur in the peripheral and central nervous systems. These changes make patients hypersensitive and more likely to experience pain. Clinical examination findings reveal multiple trigger points- these are taut bands of muscle which, when pushed (palpated) on examination reproduce the pain. There are various treatment types for these trigger points.
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.
As Botox works by either paralysing or weakening some muscles and nerves, it can effectively block out the pain caused by fibromyalgia. The patient often feels a significant improvement to the symptoms they experience.
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. Small cosmetic needles are usaully 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.