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Botulinum neurotoxins (BoNT) are enzymes produced by a type of bacteria called clostridium botulinum. They are considered the most potent biological toxins that can affect humans.

BoNT have long been known for their paralytic effects on human voluntary musculature by inhibiting release of the neurotransmitter acetylcholine at neuromuscular junctions. This paralysis can produce a variety of therapeutic benefits in a variety of health conditions such as muscular hyperactivity, glandular hypersecretions, and pain.
Although BoNT are valued in the medical world for their therapeutic applications, they are more widely known as the cause of botulism, a life-threatening state of paralytic poisoning caused by ingestion of BoNT. In 1793, the first known outbreak of botulism occurred due to consumption of spoiled sausage in southern Germany. The German physician and poet Justinus Kerner published the first accurate description of the clinical symptoms of botulism. Botulus, in Latin, means “sausage.” Kerner was also the first to postulate that the toxin might be used for therapeutic purposes.
Modern BoNT treatment was pioneered by Alan B. Scott and Edward J. Schantz in the early 1970s, when the Type-A serotype was used in medicine to correct misalignment of the eyes. From ophthalmology, BoNT rapidly spread into numerous medical specialties. In fact, BoNT is the therapy of choice for many of its therapeutic indications, and for some indications it has revolutionized treatment strategies altogether. Today we refer to these treatments as Botox, the name given to it by corporate manufacturers.

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There are seven distinct botulinum toxins produced by different strains of the bacterium. However, BoNT Type A is considered to be the most important active ingredient in pain medicine. BoNT Type A is purified and marketed as Botox by Allergan, Inc.
Botox decreases muscle activity by blocking overactive nerve impulses that trigger excessive muscle contractions or glandular activity. In addition, Botox is believed to influence the pain sensory system by inhibiting the release of neurotransmitters involved in the transmission of painful sensations, although the exact mechanism of action is unknown.
The effects of Botox are not permanent. With time, nerve impulse activity and associated muscle contractions resume over the course of a few to several months, depending on the individual patient and the indication for which they are being treated. This necessitates periodic treatments to maintain the therapeutic effects of the drug.

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Although Botox is most commonly known for its cosmetic, wrinkle-reducing effects, which it achieves by inhibiting contraction of dynamic muscles in the face, and its ability to counteract hyperhidrosis (excessive sweating), it is also highly effective in the treatment of various pain conditions.

Proponents of BoNT suggest its properties can decrease muscle spasms, ischemia, and inflammatory markers, thereby reducing pain in such conditions.

Some of the painful conditions treated by Botox include chronic pain conditions, low back pain, sciatica, migraine headaches, neuropathic pain, complex regional pain syndrome, and pelvic pain.

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A significant benefit of Botox is that it is a minimally invasive treatment. Often, it alleviates pain so effectively that patients are able to avoid more invasive procedures, such as open surgery. Another benefit of Botox is that its effects are not permanent. This allows the patient to discontinue the treatment without lasting effects if desired.