Botulinum Toxin Injections for Back Pain

Botulinum Toxin Injections For Back Pain: Uses, Expectations, Side Effects - Wilderman Medical Clinic
Published On: February 12th, 2024
5.5 min read

Botulinum Toxin Injections for Back Pain

Botulinum toxin injections (BTI) are best known for their use as a cosmetic treatment for wrinkles; however, BTI also makes for an excellent pain management medication (Witmanowski & Błochowiak, 2020).

BTI works by relaxing muscles through paralysis and blocking pain in the nerves. It lasts about 12 weeks and is considered a safe treatment for people who have chronic pain related to a muscular or nervous disorder (Padda & Tadi, 2023). The use of BTI for back pain is considered an off-label treatment, meaning that it is not a formally approved use of BTI.

How Does Botulinum Toxin Work?

BTI is essentially the introduction of a safe and purified bacterial strain of Clostridium botulinum, responsible for botulism food poisoning, into the body through an, or a series of, injection(s). The bacteria create a substance that prevents the neurotransmitter acetylcholine from binding to the muscle’s receptors.

Through this mechanism, BTI prevents those muscles from contracting, forcing them into a state of relaxation, also known as muscle paralysis. This allows strained muscles to rest and recover from any injuries that may be causing pain.

Furthermore, blocking acetylcholine from attaching to nerves reduces its ability to transmit pain signals to the brain. This leads to less overall pain as the brain doesn’t receive those signals.

This is why BTI is a good pain management option for people with muscle- or nerve-related pain issues, especially if other treatments haven’t provided good results. It provides long-term pain relief with a minimally invasive procedure and few side effects.

Botulinum Toxin Injections for Back Pain

Back pain is a general term used for multiple pain conditions (Padda & Tadi, 2023). While it is commonly used to indicate lower back pain, it can refer to any pain felt across the back.

The use of BTI for chronic pain conditions is well established and considered a safe option when conventional treatments do not provide adequate relief. However, botulinum toxins have a limited therapeutic window the doses where the medication is safe and helpful. As such, the number of BTI an individual can receive over a year is limited.

BTI is used for analgesic purposes at a specific location and often should be done with the guidance of an ultrasound or a nerve stimulator to prevent any injury. It is often done through a series of injections in and around the chosen location, with each injection having a fraction of the treatment dose.

BTI is most effective for the relief of back pain caused by muscle spasms rather than an inflammatory or neuropathic pain response.

What to Expect

BTI is a series of injections in and around a specific area, usually at the source of pain, by a trained medical professional. On average, a Botox treatment takes 3 to 4 days to take effect and 2 weeks before it achieves its optimal pain-relief effectiveness.

This relief lasts around 10-12 weeks, though it may differ depending on the individual and the underlying cause of the back pain. It is recommended that BTI be used as part of a long-term chronic pain treatment plan.

The results of BTI treatments depend on the underlying cause of the pain, with some disorders being more reactive to BTI than others. For myofascial pain syndrome, about 40% of individuals benefit from BTI treatments (Cartagena-Sevilla et al., 2016). For piriformis syndrome, BTI is most effective when used in conjunction with physiotherapy and steroid injections (Vij et al., 2021).

BTI is most effective for back pain caused by muscle spasms, with 76% of people finding BTI to be helpful (Jazayeri et al., 2011).

Who Else can Benefit from Botulinum Toxin Injections?

BTI is generally recommended as a treatment for disorders involving musculoskeletal and/or neuropathic pain (Padda & Tadi, 2023). These disorders include spasticity and dystonia, disorders that cause uncontrollable muscle spasms or contractions; severe gynecological pain during sexual intercourse or menstruation; chronic migraines or cluster headaches; and/or chronic joint pain.

Other disorders that may benefit from BTI are abnormal sweating (hyperhidrosis), bladder dysfunctions, neurogenic thoracic outlet syndrome, and/or post-herpetic neuralgia.

Side Effects

As with anything else, BTI can have side effects, some of which can be dangerous. Most side effects are benign and will quickly disappear on their own. These side effects include discomfort at the injection site, mild headache, fatigue, flu-like symptoms, and nausea or vomiting.

Some side effects can take up to 2 weeks to disappear: drooping eyelids, excessive salivation, and mild facial paralysis (they may only appear after injections to the face). Some more serious side effects that may require medical assistance are long-term dry eyes or an infection.

However, some serious side effects require immediate medical attention. If you experience any difficulties breathing, swallowing, or speaking; sudden generalized muscle weakness; and/or sudden issues with your vision, please call your emergency services. These serious side effects are rare.

Additional Suggestions to Help Manage Back Pain

BTI is recommended when included as part of a more thorough chronic pain management plan. This plan may include physiotherapy, steroid injections, and medication. In some cases, your medical team may recommend changes to your lifestyle (Ondrejkovicova et al., 2017). Things such as ensuring your seat supports your back appropriately, that any desk or workstation is at the appropriate height and distance from you, and using safety equipment or techniques when lifting objects can make a significant difference in preventing or reducing back pain.

It is recommended that an individual with back pain stop smoking, and excessive drinking, and increase their physical activities, in a reasonable and incremental manner, to help reduce possible causes of back pain. These physical activities should include back stretches and low-impact activities.


Cartagena-Sevilla, J., García-Fernández, M. R., & Vicente-Villena, J. P. (2016). Analgesic Effect of Botulinum Toxin A in Myofascial Pain Syndrome Patients Previously Treated with Local Infiltration of Anesthetic and Steroids. Journal of Pain and Palliative Care Pharmacotherapy, 30(4), 269–275.

Jazayeri, S. M., Ashraf, A., Fini, H. M., Karimian, H., & Nasab, M. V. (2011). Efficacy of botulinum toxin type A for treating chronic low back pain. Anesthesiology and Pain Medicine, 1(2).

Ondrejkovicova, A., Petrovics, G., Svitkova, K., & Balogh, V. (2017). Is non-pharmacological treatment an effective option for chronic low back pain? PubMed, 38(3), 169–172.

Padda, I. S., & Tadi, P. (2023, November 6). Botulinum toxin. StatPearls – NCBI Bookshelf.

Vij, N., Kiernan, H., Bisht, R., Singleton, I. M., Cornett, E. M., Kaye, A. D., Imani, F., Varrassi, G., Maryam, P., Viswanath, O., & Urits, I. (2021). Surgical and Non-surgical treatment options for Piriformis Syndrome: a literature review. Anesthesiology and Pain Medicine, 11(1).

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