In our desperate wish for pain relief, we sometimes receive treatment that is harmful. One of those treatments may be botulinum toxin, frequently provided as Botox injections to tender muscles. A recent article showed how Botox could produce permanent damage in muscles with normal muscle fibers being replaced with fat cells.

When there is no understanding of the mechanisms producing muscle pain, it is striking that poisoning the muscle is an acceptable intervention. Steroids injected into muscle are also generally nonsensical but are considered as a standard of care in many pain centers. There is a wealth of literature on muscle pain mechanisms and numerous theoretical models to evaluate and treat muscle pain, but this information is not generally taught in medical school or in post graduate training.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY
“Your New York City Pain Relief Doctor”


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