YOKOSUKA NAVAL BASE, Japan — What’s the first thing that pops into your mind when you hear the word “Botox”?

If you answered “wrinkles, cosmetic surgery, aging starlets” or any variation on that theme, you’re like 100 percent of Dr. Josh Duckworth’s patients when he brings up Botox therapy at U.S. Naval Hospital Yokosuka.

Though it’s the obvious connection, Botox does more than just keep crow’s feet from making a permanent landing.

Duckworth uses botulinum toxin injections, better known by the brand name Botox, to treat an array of neurological ills including migraines and chronic pain.

“You might think that because you’re forward-deployed in Japan, you don’t have access to cutting-edge medicine, but you do,” Duckworth said. “While we are limited in some ways, it would be hard to get this treatment anywhere else.”

Duckworth, 39, has been using Botox on his patients in Yokosuka for a year and travels to bases throughout Japan to meet the ever-growing demand for it, he said.

He has between 60-80 Botox patients and is adding more at a rate of about 20 a month, he said.

Because the Food and Drug Administration has approved Botox therapy only for disorders that cause involuntary muscle movement, facial spasms or excessive sweating, patients sign consent forms if they are receiving Botox for another neurological problem, Duckworth said.

Patient Sherry Hatton said she didn’t think twice about trying Botox.

The Morale, Welfare and Recreation clerk has suffered from painful migraines for six years, and “when you’re in that much pain, you’ll try anything,” she said.

Duckworth is the only doctor who hasn’t offered her another pill to take, she said.

“He is very proactive,” Hatton said. “He wants to help me prevent migraines from occurring.”

Generally, Botox blocks nerve impulses that tell a muscle to contract or send pain signals to the brain, Duckworth said.

He said he’s also used it with pain associated with shingles and has seen good results all around.

Not bad for “one of the most toxic neurochemicals known to man,” Duckworth said, explaining that the drug comes from a purified form of Clostridium botulinum — the bacteria causing the infamous food poisoning botulism.

Duckworth, a Navy lieutenant, has been in the military 13 years, starting as a tankman with the Marine Corps, he said. He has been providing Botox treatment for four years, he said, starting with his residency at the National Capital Consortium, a military medicine education facility. As with any medication, “there is bad with the good,” Duckworth said.

After an injection, patients can suffer side effects such as muscle weakness and, if you get shots in your forehead for migraines, the strange sensation that “your forehead is sinking,” said Duckworth, who has tried it himself.

Because Botox is a toxin, the body also develops antibodies to it after a while, Duckworth said.

And it’s not cheap.

It costs $485 per vial, and while most patients are “one-vial customers,” some are two, Duckworth said.

While Botox therapy is fully covered under Tricare, pay patients and retirees need pre-approval for the treatment, he said.

But he said it can pay dividends for patients, potentially replacing expensive and tedious pain medication and cutting down on hospital visits.

“It will save the military thousands of dollars, as some of my patients are on four to six medications a day — and some of those are $71 a pill,” Duckworth said.

But don’t expect the military to pay for its most common use in any circumstance, Duckworth said.

“I doubt the military will ever approve it for cosmetic uses,” he said.