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Botulinum toxin
Product description
Botulinum toxin is a potent neurotoxin that causes muscle paralysis by blocking the release of acetylcholine at neuromuscular junctions. Minute amounts of Botulinum toxin A have been used to decrease muscle spasm and pain in various pain syndromes. The Canadian Agency for Drugs and Technologies in Health (CADTH), via a working relationship developed between WorkSafeBC and CADTH, reviewed the evidence of efficacy and effectiveness of some off label uses of Botulinum toxin.
The evidence
There is no high level of evidence on the efficacy/effectiveness of Botulinum toxin treating cervicogenic headache, migraine headache, piriformis syndrome, thoracic outlet syndrome, complex regional pain syndrome, muscle spasm of various anatomic origins and myofascial pain syndrome.
There is limited evidence on the effectiveness of botulinum toxin for detrusor external sphincter dyssynergia.
The 2007 Cochrane review revealed that among chronic neck disorder patients, with or without radicular findings or headache, intramuscular injection of Botulinum toxin resulted in similar effects to saline injection in improving pain (Peloso P, Gross A, Haines T, Trinh K, Goldsmith CH, Aker P, Cervical Overview Group. Medicinal and Injection therapies for mechanical neck disorders. The Cochrane Database of Systematic Reviews 2007, Issue 3. Art.No.:CD000319.)
In January 2009, following a safety review by Health Canada, labeling information of BOTOX® and BOTOTX Cosmetic ® include the risk of the toxin spreading to other distant parts of the body. Possible symptoms of “distant toxin spread,” which can be fatal, include muscle weakness, swallowing difficulties, pneumonia, speech disorders, and breathing problems.
Coverage decision
Coverage indications
WorkSafeBC will pay for Botulinum toxin for the following medical indications:- Cervical dystonia (spasmodic torticollis)
- Primary axillary hyperhidrosis
- Strabismus
- Blepharospasm
- Dynamic equinus foot deformity
- Spasticity (to be distinguished from spasm)
Non-coverage indications
WorkSafeBC will not pay for Botulinum toxin for the following indications:- Cervicogenic headache
- Migraine headache
- Piriformis syndrome
- Thoracic outlet syndrome
- Complex regional pain syndrome
- Muscle spasm of various anatomic origins
- Myofascial pain syndrome
- Chronic non-specific neck pain
Pre-authorization
All requests for Botulinum Toxin requires case manager approval, with advice from a WorkSafeBC medical advisor
Criteria for number of injections
Due to antibody-mediated resistance and decreased response in patients receiving repeated injections, subsequent injection(s) will only be approved based on demonstrable positive response – reduced pain and improved function.
Invoicing
To bill for Botulinum toxin injection, use applicable MSP Teleplan fee code 01156, or 01157, or 00424.
Do not bill fee code 19519 expedited sessional anaesthesia (expedited block procedure).