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WCN: Botulinum Toxin Relieves Neck Pain in Cervical Dystonia By Richard Robinson Special to DG News LONDON, ENGLAND -- June 18, 2001 -- Injection of botulinum toxin type A (Botox) provides significant relief of pain from cervical dystonia, according to a study presented today at the 17th World Congress of Neurology in London, England. The relief, however, may not be due merely to reduction of muscle contractions. Botulinum toxin has been used for almost 20 years to treat the excess muscle contractions associated with cervical dystonia, a disorder in which overactive muscles twist the neck and head into abnormal postures. Patients with cervical dystonia often report relief of pain with botulinum toxin type A (BTX-A) injections, but these effects have rarely been tested directly in clinical trials, according to Maja Relja of the University of Zagreb Medical School in Croatia, who presented the findings of the study. To examine the effects of BTX-A on pain, Dr. Relja enrolled 12 patients in a three-month, double-blind, placebo-controlled trial. Patients received injections of either placebo or BTX-A (mean dose 162 units of Botox) to the most affected neck muscles. Patients were scored weekly on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), which measures severity of dystonia, and kept home diaries of severity of pain (on a scale from 0 to 3) as well as frequency (on a scale from 1 to 5). A statistically significant reduction in both frequency and severity of pain was found beginning at week 1 for BTX-A (p<0.05) versus both placebo and baseline. These differences remained significant throughout the 12 weeks of the study. Surprisingly, the relief of pain occurred a full week before the onset of muscle weakness. TWSTRS scores showed significant improvement beginning at week 2, the typical delay to onset of effect with BTX-A. There was no significant difference in adverse effects for treatment versus placebo groups. "Botulinum toxin does effectively reduced pain in cervical dystonia," Relja concluded. "It has been widely assumed that pain relief is a consequence of symptomatic muscle relaxation," Relja said, "but our results suggest another mechanism may be operating." Possible mechanisms include a direct effect on muscle spindles, but this awaits further testing. Related Link: botulinum toxin type A (Botox). E-mail this page to a friend or colleague! To print, use this version