Use of Botulinum Toxin Type a in Pain Management: A Clinician's Guide

The treatment of painful syndromes of muscle remains incompletely understood and controversial. While the use of botulinum toxin type A (BTX-A) in the treatment of conditions associated with involuntary muscle contraction, such as focal dystonia and spasticity, is supported by prospective, randomized clinical research, comparable research in pain syndromes remains to be fully explored. Accordingly, therapy with BTX-A for such "off-label" use should be carefully considered. This introductory guide provides both general direction and practical details for the busy clinician, based upon similar applications in a variety of neuromuscular disorders. The text highlights essential features one should know about BTX-A before treating patients for pain, and provides references to more detailed information. Anatomic drawings for injection localization and accompanying dosing information are included as general guidelines; therapy with BTX-A must always be individualized, not only for the patient's needs but also for the clinician's expertise. This handbook is a convenient reference source and companion to clinical training in the use of botulinum toxin. Key features of this clinical guide include: Practical, easy-to-read introduction to an emerging treatment for painful syndromes associated with involuntary muscle contractions Key facts about botulinim toxin type A Overview of myofascial pain syndromes Trigger point injections: evidence in the literature Treatment of painful spasticity and dystonia Equipment and injection techniques, including the use of EMG for injection localization Sample documentation templates Coding and reimbursement for pain and botulinum toxin type A Seminar and workshop information