 One hundred sixty subjects will be randomly assigned to one of four arms placeboplacebo, placeboBotox, Botoxplacebo, BotoxBotox. In the first of two phases, randomized subjects will blindly receive either Botox study arms Botoxplacebo and BotoxBotox or placebo study arms placeboplacebo and placeboBotox injection into the lumbar paraspinal muscles. The subjects will be assessed using validated scales for pain and disability prior to injection and monthly thereafter for four months. In the second phase, a second set of lumbar injections will be administered based on the initial randomization and will blindly receive either Botox study arms placeboBotox and BotoxBotox or placebo study arms placeboplacebo and Botoxplacebo injection into the lumbar paraspinal muscles. The subjects will again be assessed using the same validated scales for pain and disability, prior to injection and monthly thereafter, but for six months to extend the monitoring period to better define the limits of duration of effect. 