Deadly Toxin Eases Back Pain

      SAN FRANCISCO, Oct. 17 (UPI) -- A toxin responsible for the sometimes deadly effects of botulism can, in low doses, spell relief for sufferers of chronic low back pain, researchers reported Tuesday.

      Injected into the affected area in tiny concentrations, within two to three days the potent poison botulinum A blunts the nerve endings that cause muscle spasms, researchers said at the annual meeting of the American Society of Anesthesiologists in San Francisco.

      In a study of 19 volunteers at the Health Sciences Center at Louisiana State University in Shreveport, the scientists found the treatment freed patients from enduring pain for up to several months. The nine subjects injected with the toxin in each side of the lower back reported significantly less muscle pain, greater range of motion and improved ability to wash, dress and perform other daily activities. The 10 patients who did not receive the treatment reported increased pain and continued muscle spasms in the lower back.

      "Unlike acute back pain, which tends to resolve on its own, chronic back pain tends to worsen over time due to a vicious, self-perpetuating cycle of muscle spasms," said Dr. Randall Cork, professor and chair of anesthesiology at LSU. "This study shows botulinum effectively breaks that cycle."

      The toxin-derived therapy has already made a mark in medical circles, having been used for a number of years to treat writer''s cramp, tremors, eye muscle disorders and conditions related to muscle spasms and even to smooth out wrinkles. The back pain application, however, is relatively new.

      "Pain management specialists reported success with botulinum for chronic low back pain, but few clinical studies have been done," Cork said, noting the therapy has also shown promise in the treatment of neck and shoulder pain.

      Though the therapy loses its effectiveness with repeated use, "most patients never need another injection," Cork said.

      In other presentations at the meeting, anesthesiologists reported that:

      -- More than half of 282 patients at Rush Medical College in Chicago said they wanted to pray before undergoing surgery. "Perhaps what we''re hearing from patients is the need for a more personal approach to medicine, an approach that, among other things, acknowledges this spiritual dimension," said Dr. David Rothenberg, lead author of the study.

      -- A review of more than 1 million surgeries performed on Medicare patients in 1998 shows outpatient procedures are safe for elderly patients. A similar assurance of safety was offered by a 1998 study, but it only covered cataract removal. The new survey also included gall bladder removal, knee arthroscopy, two common types of hernia operations, hand nerve surgery, treatment of an enlarged prostate, mastectomy and dilation and curettage, a procedure to diagnose and treat problems of the uterus, said lead study author Dr. Lee Fleisher of Johns Hopkins University.

      "The finding is reassuring, considering the rapidly growing number of surgical procedures being performed on an outpatient basis in hospitals and ambulatory facilities," Fleisher said, noting more than 70 percent of surgeries are performed in an outpatient setting.

      -- A study of 25 women indicated spinal anesthesia results in higher pregnancy rates than does general anesthesia -- 50 percent versus 33 percent, respectively -- in egg retrieval procedures for in-vitro fertilization. The variation could be due to the different ways the two types of anesthesia affect the body, said Dr. Bobbie Jean Sweitzer, who led the study at Massachusetts General Hospital in Boston.

      -- Some 33 percent of women who undergo mastectomy suffer "phantom" pain and other sensations after their breast has been removed, feelings similar to those experienced by some leg or arm amputees. "Women who choose to have breast reconstruction surgery after mastectomy are just as likely to experience phantom breast sensations and pain as women who opt not to undergo breast restoration," said Dr. Srinivasa Raja, who led the study of 279 women at Johns Hopkins.

      -- Morphine inhaled through nebulizers -- the same respiratory device used by asthma patients -- offers pain relief to patients following chest surgery or injury. The lightweight devices that deliver a fine mist of pain killer into a mask worn over the mouth could easily be used by patients or administered by their caregivers in their homes, allowing earlier hospital departure, said Dr. Lennart Fagraeus, chair of anesthesiology at Christiana Care Health Systems in Newark, Del.

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