Discussions that mention botox

Pain Management board

Hey matt, I don't know why it's so hard to get a surgical opinin these days. If youhave neuro sdysfunction, you need to be evaluated. I would be t part of the problem is having more than one problem. It really seems to throuigh docs if you have bilateral leg pain from lumbar problems or have both cervicle or lumbar problems. The first question they ask is which is worse, that's what they will focus on.

Strange you mentioned Chiari malformation, my wife has the same problem. It didn't appear untill after she was rer ended and developed abscent seizures. I found the same info too about Chiari, Some believe many people will go through there whole life and never have a symptom and others sebase the need for surgery based on symptomology. Something that has helped my wife reduce pain meds drasticlly is Botox. The relieve the constant state of spacticity inher neck that causes the head pain. She doesn't have true headaches, it's head pain and muscular from the malformation. So botox, TP injections and occipiptital blocks have helped her reduce pain med intake by 2/3rds.

Personally I would demand a surgical consult, preferabbly with a neuro surgeon that specializes in the spine, chiari and the tumor. Obviously the DX sounds worse in your cervicle spine and if you tell them your thoracic or lumbar cause more pain, it's gonna confususe the brilliant docs with no common sense.

I have never met a PM doc that believed only meds will help, In fact the majority didn't believe in opiates, but I've been dealing with CP since 93. A multi disciplinary aproach will always help more than a single aproach. But if your PM doc doesn't use botox, or doesn't do trigger point injections, he's not going to offer it to you. They offer what they know, so the best bet is to find a group of docs from multiple specialties practicing PM that can put their heads together and find the best treatment plan for you. Even if all they can do is manage the pain, there is still more than one way to manage pain. If botox would relieve 15% of your neck pain, why wouldn't they try other than lack of experience and they simply don't want to deal with the paperwork hassles of using a drug "Botox" that is considered a biological agent with potential weapon/terrorist use. So it draws more attn and creates more work for a practice or doc that uses it. The same is true for pumps and SCS , if a doc doesn't use them, manage them or implant them, your average physicatrist isn't going to recomend one. It's just how it is, a lot of ego involved and conviction is his own opinion that is based on what, all his experience with something he doesn't use?

Your story just reinforces my disgust with non surgeons that give surgical opinions. The key word is "OPINION" if your not a surgeon, how do you give a surgical opinion. Perhaps things have changed in the last 5 years and there are devices, techniques and things a surgeon or a PM doc that does interventional procedures is capable of trying that your present PM may never try if he's alone in an office and does no interventional procedures like ESI, nerve blocks, RFA, TP's etc.

Anyone can write a script, but don't let a script writer condemn you to a life of pain for next 40 years with a his DX when you haven't gotten a recent surgical opinion or the chance to try dozens of different modalities available. He will never offer something if he doesn't do it himself or believe in it. What's his basis for not believing something else would work, it's not because he tried and it failed. That's the real test. If something effects you so greatly, it seems hard to justify not trying something that even has the slightest chance of helping.

I you think of pain as a circuit, you can dampen the charge that circuit carries with opiates at one point, the opiate receptors. It doewsn't mean you can't attack different points of that circuit with other modalities to greater reduce the charge the circuit carries. Imagine a hose, If you fold it one time, water still flows out the end, But if you fold it at 4 different points, your more likely to stop the flow entirely. Using opiates alone is simply putting you foot on one spot of the hose hoping to stop the flow of water. The more points you attempt to stop the flow or dampen a circuit, the more successful you will be. That's what a multi disciplinary aproach to PM is.

Good luck, Dave