Local Neuropathic Pain
Neuropathic pain is a complex, chronic pain state, most often accompanied by a tissue injury. The condition is typically characterised by a burning and shooting pain, along with a feeling of tingling and numbness.
The term gets its origin from ‘neuro’ which means nerves in Greek, and ‘pathy’, which means abnormality. In general, pain specialists classify the physical causes of pain into two types, the nociceptive and the neuropathic pain. The nociceptive pain is temporary and is caused by sprains, bone fractures, burns, bumps, bruises and inflammation. On the other hand, if the neuropathic pain is chronic (continuous) it suggests an abnormal functioning of the central nervous system.
Neuropathic pain is usually the result of an injury or malfunction of the peripheral or central nervous system. Localised neuropathic pain is where the pain occurs in a specific nerve or trigger point.
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.