Albany Med specialist uses Botox for treatment of pain

Conditions associated with painful muscle spasm such as headache, low back pain, chronic neck pain,
Howard Spector of Long Island receives Botox injections to his neck from Dr. Charles Argoff at Albany Medical Center.
PHOTOGRAPHER:
Howard Spector of Long Island receives Botox injections to his neck from Dr. Charles Argoff at Albany Medical Center.

For most of his adult life, Howard Spector, 57, got up every morning, put on a suit and went to work as a men’s clothing salesman.

Then in 2002, Spector, who lives in Syosset, had vascular surgery in his lower left leg, and doctors hit a nerve. Since then, his leg has been in constant pain.

His internist referred him to Dr. Charles Argoff, then director of the Chronic Pain Management Center at North Shore University Hospital in Manhasset.

After trying several therapies, in 2004 Spector received Botox injections and nerve blocks to numb his pain. Although he is not pain-free, Spector said the Botox has been a big help.

“It’s not a magic bullet, but it gives me some relief,” he said. “Without the Botox, I wouldn’t be functioning at all.”

When people hear the word Botox, they commonly associate it with its cosmetic uses. As early as 1989, however, Botox, was being used to treat eye muscle disorders such as eyelid spasms and crooked eyes. It has also been approved by the FDA to treat muscle spasticity, movement disorders, bladder spasm and excessive sweating.

Recent disoveries

More recently however, it has been discovered that Botox can significantly reduce pain associated with migraine headaches, daily headaches, and other nerve injury types of pain, said Dr. Charles E. Argoff, professor of neurology at Albany Medical College and director of the Comprehensive Pain Program at Albany Medical Center for the past three months.

“Although considered an off-label use of Botox at this time, there have been many studies to support the use of Botox as a pain reliever,” said Argoff. “And there is significant research ongoing in an attempt to gain FDA approval for headache treatment.”

Botox is the brand name for botulinum toxin A, a type of toxin produced by the bacteria Clostridium Botulinum. The toxin interferes with nerve impulses to muscles by blocking the receptor site for the appropriate neurotransmitter. When the paralytic agent is diluted and specially treated, it can be injected to create temporary muscle paralysis.

“There is always a lag time between when you might find a drug useful and when it may get approved,” said Argoff.

Still, Argoff said he treated hundreds of patients for migraine headaches and chronic pain at North Shore University Hospital, before moving to Albany Med.

Many health insurers decide to cover the cost of Botox when they see the benefit, he said.

“I’ve seen people who have not benefited from anything else, people who just know this makes a difference in their lives,” said Argoff. “It’s been my experience that by working with insurance companies and showing the rationale for using this treatment, health insurers have been willing to help individuals with this treatment.”

Argoff said conditions associated with painful muscle spasm such as headache, low back pain, chronic neck pain, spinal cord injury pain, pain from shingles, tennis elbow, and carpal tunnel syndrome, are being studied and successfully treated with Botox.

“Given that 25 to 30 million people in this country are affected by various types of headache, the real beauty of using Botox is in helping those people,” said Argoff. “It’s been shown to be extremely effective.”

Botox, which is manufactured by Allergan, is expensive. A vial of the toxin cost $500 and one treatment might require one or more vials at three- to four-month intervals. Depending on the area that needs to be injected, a person could use four or five vials at one time.

“On the flip side, there have been studies done regarding people being treated for headache, and there is reduced consumption of other medications, and reduced visits to hospital emergency rooms,” said Argoff. “So while you spend X amount of money up front every three months, your total annual cost may go down because people are more productive, there is less absenteeism, and people have a better quality of life.”

Argoff said studies show the best results are obtained three to six months after multiple treatments.

“And given properly, this is a very safe drug,” he said. “If you stick within the guidelines, you’re not going to hurt anybody.”

Side effects may include some weakness where people are injected and pain in the injection site.

“But it is not a toxic drug when used appropriately,” Argoff stressed. “And for some people, these treatments are lifesaving.”

So far in his three months in Albany, Argoff has treated about eight patients with Botox. All have been covered by their insurers and all are doing well.

“I still have some patients who come up from New York to see me because it’s been so successful,” he said.

Finding candidates

Argoff said he hopes future studies will help doctors to identify quickly who is most likely to benefit from Botox treatments.

“Certainly for somebody in pain, it’s important to identify the most effective treatment or pain reliever as soon as possible,” he said.

Argoff was involved in several studies of Botox in the past in New York, and plans to become involved in studies at Albany Med in the future.

“We’re speaking to Allergan about collaborating with doctors in the Neurosciences Department who are also interested in some of the basic mechanisms of how Botox works, he said.

Spector who drives three hours both ways to see Argoff, said he could not function without Botox. He also receives Botox in his neck to treat arthritis.

“Before, I was in total pain,” said Spector, who receives injections every three months. “It was a sharp, burning sensation, and it was awful. I still have some of the burning, but the Botox numbs most of the area. It gives me some relief and allows me to function.”

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