Published in the journal of Pain Medicine, April edition, researchers offer a noninvasive alternative treatment for Thoracic Outlet Syndrome (TOS) patients by using Botox instead of the last course of action being surgery. In surgery removal of the first rib and severing one of the muscles is done.
Botox may just not be for cosmetic reasons anymore. The injection received in face to smooth out the wrinkles. Botox is a recognized toxin that weakens or paralyzes particular nerves and muscles.
Researchers at John Hopkins have discovered that patients with TOS may have an alternative treatment available. Studies have indicated that possible eight percent of the population have revealed a major decrease in short term pain after receiving one low dose injection of Botox administered in a neck muscle.
According to Paul J. Christo, M.D.,M.B.A and assistant professor of anesthesiology and critical care medicine at John Hopkins University School of Medicine, and head researcher of this study. Stated that currently there have not been many alternatives to surgery for this syndrome. Botox appears to be a adequate treatment in order to avoid surgery and the known disadvantages such as intrusive nature and immense recovery length.
Dr. Christo goes on further to state this latest study greatly increases past studies where TOS patients had received a few Botox injections which were done more without direction and without the help of CT scans.
TOS is due to compression of nerves in the lower neck, and happens when there is not ample room in the cavity between base of neck and armpit (thoracic outlet) in order for nerve impulses to go through without constraint. Symptoms of this disease usually begin in the neck or head and radiate down the arm causing immense pain, numbness and or weakness in the arm and appendages. This condition usually is caused from trauma from motor vehicle accidents or by sitting at computer in the wrong position for an extended length of time, weightlifting or by extra rib that sometimes appears in neck. Treatments include physical therapy, anti inflammatory medications and surgery.
Researchers examined 27 patients who were contenders for surgery to treat their TOS due to the failing of physical therapy and anti inflammatory medications to treat them. Each patient received a 20 unit injection of Botox. Botox contains botulinum toxin which is derived from the same bacterium that causes botulism a form of food poisoning that paralyzes and is life threatening. Using a CT scan as a guide, Dr. Chirsto was able to place the needle in the patients anterior scalene muscle located in the neck. Sessions ran about one minute in duration and required little radiation.
Patients had an important reduction in pain for each of the two months after injections. At three months patients still experienced a 29 percent reduction in TOS related pain. This is measured by the scientific pain scale.
This average amount of decreased pain can have a important meaning on a patients life. For a lot of patients they will be able to do what they could not do for themselves before, such as brushing hair and teeth.
Dr. Christo states the reasoning of the Botox working to briefly relieve pain in TOS patients is due to the fact the paralyzing action lessens the strain and spasms of muscles, decreasing pressure on the nerves as more area is made for them to get through the thoracic outlet. Botox may also decrease pain by lessening the amount of neurotransmitters that alert the brain the body is in pain. Even though the study observed pain, some patients seem to have displayed more arm and should functioning due to the Botox injections.
The drugs results diminish in a couple of months. The same amount of time as used when injected into face for wrinkles. Dr. Christo stated that patients should be able to have several injections of Botox into muscles over a length of time. However, some persons may produce antibodies to the compound with over abundant use, which in the long run the toxic would not be able to block the pain.
The study noted 48 percent of patients did continue on to surgery. Dr. Christo added this was due to the fact of a lot of the patients who agreed to be part of the Botox study just to receive a amount of pain deduction before their surgery date. The other patients became part of the study with hopes of not having to receive the surgery Not all patients are suited for Botox treatments.
Dr. Christo commented that he would like to do more investigation of using Botox for TOS patients and do long term follow ups with those who receive injections.
There are alternative therapies available for TOS for patients to look into. They include the following:
Chiropractic First thing the chiropractor will do is examine and palpate the function and mobility of first rib and vertebra in neck to check for proper movement.
Chiropractic treatments may include beginning with exercise to loosen up tight muscles and joints around compressed nerves and blood vessels. Stretching of the joints, muscles and nerves may be prescribed. Deep muscle work may also be received to help breakdown any scar tissue and adhesion's which develop in the muscles and tendons. Chiropractic treatments aides in increasing motion in the shoulder blades and arms.
Acupuncture treatments received two to three times per week for a duration of four weeks. Improvement is usually noted within eight to ten treatments. Pain, burning and tingling is greatly diminished. Pain medications are then usually reduced or not used any longer. Upper extremity function becomes greater and enables patient to do daily routines with more ease.
Massage therapists use many different techniques to provide relief. This is can be done through Neuromuscular or Trigger Point therapy. This helps to rid trigger points in the scalene muscles and other front neck muscles.