Botulinum toxin in pain therapy: wide range of applications

Botulinum toxin is not only used in medicine for aesthetic treatment, but also plays an important role in pain therapy. By specifically blocking the release of acetylcholine at the nerve endings, overactive muscles can be relaxed, pain reduced and chronic complaints treated.

Some of these applications are officially authorised, others are considered off-label use. Off-label use is the use of a drug outside its originally authorised indication. Such treatments are based on scientific studies and clinical experience, but are not approved by the regulatory authorities for the specific purpose.

Pain therapy with botulinum toxin: treatments at Medical Contour

We offer the following treatments with botulinum toxin in pain therapy:

1. Bruxism (teeth grinding)

Bruxism leads to excessive activity of the masticatory muscles, especially the masseter, which can cause pain in the jaw joint, tension and headaches.

• Treatment: Injections into the masseter reduce muscle activity and can reduce pain and tension.
• Status: Off-label.
• Note: We always perform this treatment under ultrasound guidance: we see the target muscle on ultrasound during the injection. More on this on our page on treatment of the jaw muscles.

2. Migraine

Chronic migraine, defined as headaches on more than 15 days a month, can be treated preventively with botulinum toxin.

• Treatment: Botulinum toxin is injected at several points in the head, neck and shoulder area to reduce the overactivity of muscles and nerve impulses.
• Status: Authorised.
• Note: We also perform this treatment under ultrasound guidance. More on this on our page Botulinum toxin for migraine.

3. Temporomandibular dysfunction (TMD)

TMD involves dysfunction of the temporomandibular joint, which is often accompanied by pain and restricted mouth opening.

• Treatment: Injections into chewing muscles such as the masseter or temporalis can reduce pain and tension.
• Status: Off-label.
• Note: We also carry out this therapy exclusively with ultrasound support.

4. Focal hyperhidrosis (excessive sweating)

Whilst hyperhidrosis is not a pain disorder in the classic sense, the accompanying symptoms such as skin irritation or inflammation can be painful.

• Treatment: Botulinum toxin inhibits the activity of the sweat glands and can thus relieve symptoms. More on this on our page on Hyperhidrosis treatment.
• Status: Authorised.

Other uses of botulinum toxin in pain therapy (not available at our practice)

The following treatments with botulinum toxin have also been scientifically investigated, but are not offered in our practice:

1. Cervical dystonia (torticollis)

This neurological disorder causes painful and involuntary muscle contractions in the neck and shoulder area.

• Treatment: Injections into the affected muscles can relieve contractions and pain.
• Status: Authorised.

2. Spasticity

Spastic paralyses after strokes or neurological diseases lead to overactivity of muscles, which causes pain and restricted movement.

• Treatment: Botulinum toxin relaxes the affected muscles and can make movement easier.
• Status: Authorised.

3. Myofascial pain syndrome

Chronic pain caused by trigger points in the muscles can be treated with botulinum toxin.

• Treatment: Injection into the affected trigger points reduces muscular overactivity and can relieve pain.
• Status: Off-label.

4. Neuropathic pain

Neuropathies, e.g. after injuries or operations, can be treated with botulinum toxin, as it inhibits the release of pain-triggering neurotransmitters.

• Treatment: Local injections at the affected nerve points can reduce the perception of pain.
• Status: Off-label.

Our approach

At Medical Contour, we place great emphasis on scientifically based and precise treatments. We treat the chewing muscles, the jaw joint and migraine under ultrasound guidance, which means we see the needle and the target structure on ultrasound during the injection. For all off-label uses, we inform our patients comprehensively so that they can make a well-founded decision. The effort involved varies greatly depending on the degree of pain and the extent of the affected areas. That is why we determine the dose and treatment plan individually after the examination. You can find an overview on our page on pain therapy with botulinum toxin.

Frequently Asked Questions

Is botulinum toxin approved for pain therapy?
For some uses, yes – for example for the preventive treatment of chronic migraine and for excessive sweating. For teeth grinding and jaw joint problems, it is used off-label. We explain this in detail before the treatment.

How long does the effect last?
The muscle-relaxing effect wears off after a few months because the body forms new nerve endings. How long it lasts varies from person to person. If needed, the treatment can be repeated.

What does “ultrasound-guided” mean?
We perform the injection under simultaneous ultrasound guidance. This allows us to see muscles, blood vessels and the needle tip throughout the treatment and to place the product precisely.