Treatment for Whiplash With Botulinum-toxin A Appears Promising; More Study NeededWhiplash injury, often caused by motor vehicle accidents but also from other accidents, such as falls, is a common neck injury that can cause neck pain and stiffness, headache, shoulder pain, arm pain, tingling, numbness, and other neurological effects.
Up to 75 percent of patients with whiplash may see their symptoms go away on their own, however, many patients require treatment for their discomfort. No treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, injections into trigger points, surgery, and others, has proven entirely effective and some are controversial.
The use of botulinum neurotoxin type A (BTXA, also known as Botox) has been investigated, however usually after a long period of time following the initial injury. The authors of this study believed that earlier intervention, at 3 months, would be more effective and prevent the pain from developing into chronic pain.
Twenty patients with a history of whiplash injury and myofascial pain, pain caused by a trigger point, were enrolled into the study. The injury had to have occurred between 2 to 48 weeks before the study onset, the pain had to be restricted to the neck only, 4 to 8 spots had to be considered to be tender spots, or trigger spots, and there could be no spinal or neck abnormality.
The patients were asked to assess their pain before the treatments using the Visual Analog Scale (VAS) of 0 to 10, with 10 being the worst pain. They also noted use of pain relievers. They were reassessed at 3, 6, 9, 12, 18, and 24 weeks following the injection of Botox.
Besides the VAS scoring, the patients were also asked to use the Verbal Rating score to measure pain, and the SF-36 questionnaire to measure quality of life. The physician measured the patients' ability to move at the neck and determined pressure pain by applying pressure to the trigger points.
Results of the study found that although there was improvement in all values among the patients who did receive the Botox injections, the differences were not statistically significant. The authors point out that although they wanted to have the patients receive injections at 3 months following the injury, it was another 2 months before treatment because the patients preferred to try less invasive treatments before proceeding to the study treatment. The authors feel that this could have played a role in the study outcome.
In conclusion, the authors state that there appears to be some efficacy with the use of Botox in the treatment of whiplash symptoms, however further study is needed.
Clara Braker, MD, et al. The Analgesic Effect of Botulinum-toxin A on Postwhiplash Neck Pain. In Clinical Journal of Pain. January 2008. Vol. 24. No. 1. Pp. 5-10.
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