Botulinum Toxin Injections (Botox Injections)

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Botulinum toxin is a substance made by the bacteria Clostridium botulinum, the same bacteria that can cause botulism. This may sound alarming; however, the substance made for medical use is an inactive form of the toxin several thousand times less potent than that needed to cause botulism.

There are several toxins produced by the bacterium Clostridium botulinum. Gradual relaxation of muscle spasm develops over one to two weeks after the injection. The reduction of muscle spasm lasts for 3-4 months and pain relief can last even longer. Conditions that are treated with Botox botulinum injections (Botox) include muscle contraction headaches, chronic muscle spasms in the neck and back, torticolis (severe neck muscle spasms), myofascial pain syndrome, and spasticity from multiple sclerosis or stroke.


Botox injections can be done in the office or at our outpatient surgery center. Where the procedure is done depends upon the size and location of the muscles injected, personal preference, and insurance coverage.  You may discuss your options with your physician as well as options regarding sedation.

In the office setting, you will be asked to change into a gown and to lie down on an examination table. The skin will be cleansed with a sterile solution. The muscles in spasm will be injected with the solution of the botulinum toxin mixed with either saline or local anesthetic (numbing) medication. If necessary, “band aids” will be placed over the injection sites.

In an outpatient surgery setting, you will be taken to a procedure room and positioned lying on your stomach on a procedure table.  For injections in deep muscles such as the piriformis, psoas, or scalene muscles your doctor may take x-rays to ensure proper needle placement. A solution of Botox and local anesthetic is then injected into the muscles. You may experience temporary numbness or weakness in a leg with the piriformis or psoas injection or in an arm with scalene injections in the neck. After being monitored in the recovery area, you will be discharged.  If you have opted for sedation medications, you will need a driver to take you home.

Temporary side effects from the injections may include increase in pain, weakness in the muscles injected, body aches, dry mouth, and hoarseness. Your physician will recommend timing for a follow up visit in the office.

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