Almost every human being has at one time or another suffered from back pain. For instance, 20% of military discharges in the United States are related to lower back pain. Most back pain disappears with unspecific treatment within five weeks. Chronic back pain, however, costs the American economy nearly 50 billion dollars every year. Older people in particular often suffer from chronic lower back pain.

At present the usual treatments include the use of nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprophen or naproxen), muscle relaxants (e.g. baclofen or mataxolone), antidepressant drugs and opioids (drugs with similar effects to opium).

The scientists who conducted this study investigated the effectiveness of a new method of treating chronic lower back pain, the injection into the lower back muscles of botulinum toxin A (trade name: Botox). Botulinum toxin is produced by the bacterium Botulinus, and is responsible for rare cases of lethal food poisoning. Injected Botox has been used successfully by doctors to treat other kinds of movement or neurological disorders such as neck pain and torticollis (a spasm of neck muscles causing a twisted neck).

The investigating doctors chose 15 men and 16 women who had severe lower back pain, which had persisted for 6 months or longer and had was either on one side or both sides of the lower back. They excluded people under 18 years old, pregnant women, people involved in litigation, the very sick and those with allergies or sensitivity to Botox. The patients had an average age of 46 (ranging from 20 to 73), and had suffered chronic back pain for an average of 6 years. During the trial the patients continued taking the medications that they previously used.

Special tests, called VAS and OLBPQ, were given to the patients before and after treatment to determine their pain level. VAS was an indication of the intensity of pain felt by the subject, and OLBPQ was a series of questions about how much their pain interfered with their everyday life.

The investigating doctors randomly divided the patients into two groups; one group of 16 being given saline solution injections, the other group of 15 received Botox injections. The patients were injected once at 5 sites on their more painful side, with either 40 units of Botox (100 units per ml) or the same volume of a saline solution, which looked identical to the Botox. Neither the saline nor the Botox injections caused any pain. Three and eight weeks later the patients were examined using the VAS and OLBPQ tests and asked about any side effects.

After three weeks, 5 of the 16 patients receiving saline injections reported pain relief, while 13 of the 15 patients receiving Botox reported pain relief. After eight weeks nine patients receiving Botox injections reported significant pain reduction and increased mobility, as did 2 of those receiving saline injections. None of the patients receiving Botox injections reported worsening pain or impaired function. Two of those receiving saline solutions, however, did. No one reported any side effects. . In several cases where information was available, the good effect seemed to wear off after three months.

The investigating doctors tried to ascertain why Botox, a toxin, would produce such good results. Lower back pain is linked to overactive muscle lower back muscles, perhaps due to accumulations of metabolic waste products. They concluded that Botox probably reduced the nerve activity in the lower back muscles and may have had an analgesic effect of its own.

They pointed out that their study was based on only a small sample of patients, and they strongly suggested further in-depth studies. They were not sure that Botox will provide long-term relief. But for them the conclusion was clear: injections of Botox significantly relieved lower back pain. For all those many people, particularly older people, who suffer from chronic lower back, this is very good news indeed.