I have had a stroke which left my right side weak. Although I can walk, there is pain in my shoulder (where my arm hangs down) and behind my right kneecap. One doctor is suggesting botox, and another doesn’t agree. Could you explain what botox does for a person?
Botox is a medicine given by injection into muscles which the doctor wants to relax, either because they are in spasm, have developed a twitch, or to reduce wrinkling. I have never heard of it being used in someone with pain after a stroke, but without knowing more about the condition, I wouldn’t want to say it should never be done.
Botox is derived from a toxin made by the bacterium Clostridium botulinum, the cause of botulism. It is one of the most powerful poisons known to man on a milligram-to-milligram basis, with only a tiny amount needed to cause death when swallowed. When food has been improperly canned or preserved, the bacteria are able to grow and produce the toxin. The toxin is tasteless and has no smell, and is not destroyed by brief cooking. Although the toxin is a protein, it is resistant to being digested and can, therefore, be absorbed when eaten.
The symptoms of botulism develop about 12-36 hours after the food is eaten, and usually include nausea, vomiting and diarrhea. The dangerous effects of the toxin, however, come from its ability to block transmission of nerve impulses to the muscles. This causes paralysis which commonly begins with the muscles of the eyes, face, mouth and throat. It may progress to failure of the muscles of respiration, requiring the person to be placed on a ventilator. With proper care, mortality now is quite low.
Since botulinum toxin is such a powerful paralyzer of muscles, it was recognized that it might have some beneficial applications if it could be administered only to specific muscles in a very weak form. Thus botox, for botulinum toxin, was developed. It is most commonly used in instances where a persistent spasm of a muscle is causing problems, for example in spastic torticollis, where spasm of one of the neck muscles causes the head to be pulled to one side. It is also used to control persistent muscle twitching which is disturbing to the person, or which is visible to others, like a visible twitching around the eyes or face. Achalasia, a condition in which spasm of the bottom of the esophagus causes difficulty in swallowing, may also be treated by injections of botox into the area in spasm.
Probably the most common use of botox now is to relax the facial muscles which cause wrinkling. Plastic surgeons often use these injections to deal with specific wrinkles, such as often occur between the eyes or at the corners of the mouth. Injections of collagen to smooth out any wrinkles which may have already formed can also be used to produce nice, smooth skin. This type of medical facelift has become very popular. Because the effects of botox wear off slowly, the injections must be repeated every three to six months.
Since the only use of botox is to paralyze specific muscles, it is hard for me to see how it would be helpful for pain in areas weakened by stroke. If the doctor believes that the pain is caused by some spasm of the muscles in those areas then botox might be indicated, but I would suggest getting a second opinion from a physiatrist. Physiatry is a fairly new specialty which deals with rehabilitation and physical medicine problems. Our writer probably saw a physiatrist at some point after having the stroke, since any physical therapy or rehabilitation might have been prescribed by such a specialist. A call to the hospital where treatment for the after effects of the stroke was administered would probably produce the name of the physiatrist.