At the end of last year I posted a summary of all the good things Botox can do, or rather those that I had been able to find out. This year the only new indication I've come across is for relieving pain in osteoarthritis of the shoulder. A paper given at the American College of Rheumatology meeting described the benefits of a single injection of botulinum neurotoxin (Botox) into the joint of patients with moderate to severe osteoarthritic pain in their shoulder. Forty-three such patients - nearly all male - average age 71, were randomly assigned to have an intra-articular injection of lidocaine-plus-Botox or lidocaine-plus-saline (placebo). Their pain was assessed after 1, 3 and 6 months. Pain levels after 1 month were significantly lower in those subjects given the Botox; 38% of them had at least a 30% reduction in their pain scores, compared with only 9% of the placebo group.

Unfortunately the results after 3 and 6 months weren't reported at the meeting; perhaps they weren't yet available. At any rate, the 1-month findings were quite impressive. Score another hit for Botox!

The theory behind the usefulness of Botox in this type of pain relief is that the toxin inhibits the vesicle release of neuropeptides, such as Substance P and CGRP, which are responsible for stimulating pain receptors in the joint. Even if Botox itself doesn't become a staple in the treatment of such patients, the findings may present an avenue for the discovery of more effective drug approaches to pain management.