Botox Injections for Whiplash Pain
Abstract of a Poster presented at the EFIC Conference in Nice, September 2000
Dr J C D Wells, Liverpool, UK
Chronic neck pain after whiplash is a significant problem in Pain Clinics, and is also a costly problem in injury litigation in the Western world. It has been estimated that 60 per cent of an insurance premium paid in the USA and in the UK goes to pay for whiplash-related injuries!
There is much argument and discussion about the aetiology of the chronic pain. However, a significant number of sufferers in clinic appear to have muscle tenderness and spasm, sometimes with associated trigger points.
For the last 2 years an open study has been conducted on the use of Botulinum toxin in selected patients with chronic whiplash, to determine whether or not there appears to be any benefit.
Seventeen patients have been treated, using dosages of 75 to 100 units of Botox into the sternomastoid and trapezius muscles. Thirteen patients reported benefit in terms of a greater than 50 per cent reduction in pain, lasting for a variable period. In 12 patients there was a demonstrable reduction in disability. In 14 patients there was a reduction in depression and in 7 patients a reduction in anxiety.
The maximum benefit appeared to occur in patients who had symptoms for less than one year, and no benefit occurred in patients who had had symptoms for more than 2 years. These preliminary results suggest the need for a double-blind trial on the use of Botulinum toxin in selected patients with whiplash pain, between 3 months and 24 months.
(Pain in Europe III)
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