Botox Decreases Pain in Breast Reconstruction Patients

Woman holding chestBotox can reduce post-operative pain in women who get silicone implant breast reconstruction after a mastectomy, according to Dr. Allen Gabriel, who presented his study at the recent International Society of Aesthetic Plastic Surgery Congress.

Dr. Gabriel, a plastic surgeon in Vancouver, Washington, did a 30-patient clinical trial for this off-label use of Botox that demonstrated that botulinum toxin A addresses the sources of severe pain associated with the procedure.

Silicone breast implantation usually involves the positioning of a temporary expander implant between layers of the chest muscle, which is filled with water to create a pocket where a permanent implant will reside. According to Dr. Gabriel, the muscle often contracts and spasms in response to the expansion, causing the patient pain.

Dr. Gabriel, along with his collaborator Dr. G. Patrick Maxwell, theorized that Botox injections could offer relief by temporarily paralyzing the muscle so that fewer spasms occur, resulting in less pain.

“The use of [botulinum] is changing the reputation of expanders as a painful part of breast reconstruction,” Dr. Gabriel said. “Before we started using [botulinum], patients leaned toward autologous reconstruction because of anxiety about expander pain. Now, patients are more inclined to choose expanders.”

The clinical trial assigned 30 breast cancer patients who were all getting a mastectomy with silicone implant breast reconstructionâ??into two groups: one group received Botox injections in the chest muscle and the other received injections of saline solution as a placebo.

The women who received the Botox injections were more comfortable after surgery than those who received placebo, Dr. Gabriel said. He measured patient responses three times during and after the procedure. He also noted that during days 7 to 45 of the recovery period, those that received Botox injections used significantly fewer doses of narcotics and muscle relaxants.

Botox Approved to Treat Migraines in U.K.

Woman with eyes closed Botox has been approved in the U.K. as a tool for preventing chronic migraine headaches. Best known as a wrinkle treatment, it can now be used on migraine patients in the U.K. who have headaches at least 15 days a month, including migraines on 8 days, according to Allergan’s press release.

The clinical trial involved almost 1,400 adults who had a history of migraines. Participants experienced 15 or more headache days of which at least half were migraine or probable migraine during the 28-day baseline period. After the baseline period, patients were randomized to receive either Botox injections or placebo.

By week 24 following treatment, those who received Botox averaged 8.2 fewer migraine days, which was significantly greater than the change from baseline observed in placebo treated patients of 6.2 days.

Migraine symptoms may include severe headache; visual disturbances such as spots or flashing lights; sensitivity to light, noise, or smells; and nausea and vomiting.

“We have been following these studies really closely and the evidence is really pretty solid. These people spend half their lives in pain. Even if they get half the attacks, it can really improve their quality of life,” said Lee Tomkins, director of Migraine Action, a charity that provides information and support to those who suffer from migraines and their families throughout the U.K. and overseas.

The U.S. Food and Drug Administration may decide this month whether the product can be sold for migraines, Aaron Gal, a Sanford C. Bernstein & Co. analyst in New York, said in May.

In the U.S., Botox can be used to treat eye muscle spasms and wrinkles, and there are also many off-label uses for Botox, such as to relax muscles in stroke patients and to treat excessive sweating.

According to statistics from the American Society of Plastic Surgeons, Botox was the number one minimally-invasive cosmetic procedure in 2009 in the United States.

Surgeons Are Still Finding New Uses For Botox

By now, it’s been firmly established that Botox injection can effectively smooth out facial wrinkles, and we’re grateful for that. But is that all we should expect from the drug?

Doctors once thought off-label use of Botox – which was originally developed for treating muscles spasms – would be fairly limited. If you do a little research however, you’ll find that physicians are using Botox for many other interesting purposes.

Many doctors use Botox to treat headaches, and their basic procedures are hardly different than those of wrinkle treatment. It isn’t entirely clear how the Botulinum toxin provides relief; it may work to inhibit certain pain-transmitting nerves. But evidently, many people suffer from fewer headaches after being treated with Botox.

As reported in the Journal of the American Academy of Dermatology, researchers from Allergan Inc. conducted surveys about sweating, revealing that almost 3 percent of the U.S. population (7.8 million people) believe their sweating to be excessive. At the time of the survey (in 2004), less than half of the respondents had sought medical help for the problem. Botox blocks the localized release of a specific chemical that stimulates sweating, and so the FDA approved it for this use years ago.

Last March, the New York Times published a story on the off-label use of Botox to help those who have suffered a stroke and have trouble relaxing certain muscles. According to the experts, “only about 5 percent of the stroke patients who could benefit from its use ever get it.”

Patients with even more obscure conditions have found success using Botox. In Feb 2008, USA Today reported that radio personality Diane Rehm (of National Public Radio) had received routine off-label treatments of Botox for a vocal disorder called spasmodic dysphonia.

Aside from these therapies, surgeons and dermatologists are finding even more cosmetic uses for Botox. Dr. Lawrence Reed recently told an ABC news affiliate that “we’re at the tip of the iceberg where Botox is going to be used.” Reed has apparently been pioneering some interesting new cosmetic applications.

For acne, Dr. Reed injects Botox just below the skin: “It decreases the muscle pump and blocks the production of oils, so we use it for acne,” he claims. Other patients of Dr. Reed found success using Botox to relax certain muscles and actually make their eyes appear larger, and to supplement laser skin resurfacing.

If you’re considering Botox for any off-label use, make sure you choose a qualified physician. Despite the optimism surrounding Botox as a ‘wonder drug’, there have been complications and side effects associated with off-label use and inexperienced providers

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