Courtesy Photo | Lt. Col. (Dr.) Chad Hulsopple, primary care sports medicine fellowship program...... read more read more
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A popular cosmetic treatment, botulinum toxin (BoNT-A), best known by the brand name Botox, may also be used to treat several different types of musculoskeletal disorders, according to a review published by researchers at Uniformed Services University (USU). The researchers reviewed existing research and evidence from their practice that suggests BoNT-A injections can provide pain relief and functional improvement in some common conditions such as chronic exertional compartment syndrome (CECS), plantar fasciopathy, tennis elbow, and osteoarthritis.
The review “Utilization of botulinum toxin for musculoskeletal disorders” was published online in the journal Current Sports Medicine Reports.
“These disorders affect a wide-range of individuals, military and civilian alike,” said Army Lt. Col. (Dr.) Chad Hulsopple, primary care sports medicine fellowship program director at USU and co-author of the review. “They cause chronic pain and functional limitations that can directly impact job and athletic performance. They can be more prevalent in the military population, due to high activity, and have an immense impact on combat readiness.”
Each of these disorders cause pain in different ways and in different parts of the body. CECS causes muscle and nerve pain, predominantly in the lower body. Plantar fasciopathy is characterized by inflammation and pain in the heel. Osteoarthritis affects the knees, shoulders, and other joints. Tennis elbow affects the elbow, and the pain sometimes extends to the forearm and wrist.
While there are several existing treatments for these conditions, there is a need for more effective treatments. The definitive treatment for CECS, surgical fasciotomy, has about a 55% success rate, with 20% of service members being referred for medical discharge. Osteoarthritis remains the most common reason for medical discharge in the military, despite the existence of several types of treatments. Several treatments also exist for plantar fasciopathy and tennis elbow, however, a number of cases resist treatment.
Army Maj. (Dr.) Clint Moore, the primary author of the study, began researching emerging therapies for these disorders during his sports medicine fellowship at USU, due to their treatment-resistant nature.
“I started looking into botulinum toxin in fellowship because we were focusing on effective therapies for the cases that failed standard treatments,” said Moore. “There are a lot of promising studies that show botulinum toxin produces results and can save patients from pain, functional limitations, or corrective surgery.”
Due to the strength of the preliminary research and limited side effects of the treatment, Moore and his colleagues started using BoNT-A injections to treat these disorders in their own practice.
“The side effects, which are short-lived muscle weakness, and the effectiveness of the therapy made it a good option when we discussed risk vs. benefit,” said Moore. “The results we’ve seen in practice closely match the research findings that BoNT-A is an effective therapy for these disorders.”
Hulsopple notes the use of BoNT-A injections on an individual basis is a result of a shared decision-making process with the patient, and that an evidence-based approach should be utilized. The injections are usually employed when pain and functional limitations are not relieved by existing treatments. Conservative management techniques such as stretches, strengthening exercises, and bracing continue to be frontline treatments, and continue to be utilized when BoNT-A injections are employed.
Although the research is promising, Moore and his colleagues point out this use of BoNT-A is off-label, meaning the drug has not been cleared by the Food and Drug Administration to treat these conditions. This does not comment on the safety and effectiveness of the drug; however, it reflects the early-stage nature of the treatment.
“This treatment is used pretty commonly in the sports medicine community,” said Moore. “But the medical community at large is not using botulinum toxin for musculoskeletal conditions. Large, long-term studies are needed to establish the efficacy of this therapy, as well as optimum timing, dosing, and method of using botulinum toxin for these conditions. Stronger studies could lead to FDA approval, which would be very helpful in increasing the use of this therapy.”
| Date Taken: | 04.15.2021 |
| Date Posted: | 04.15.2021 07:44 |
| Story ID: | 393891 |
| Location: | BETHESDA, MD, US |
| Web Views: | 855 |
| Downloads: | 0 |
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