Discussions that mention botox

Pain Management board

I have been suffering for 5 years with hard core pain in my upper back, specifically the Rhomboid Muscles and under my shoulder blade. I had asked about Botox injections for this type of condition since day one and was literally laughed by many doctors and simply dismissed by others. This is despite the fact that Botox use for muscle spasticity has been progressing heavily in the last 10 years. I even brought in Jama articles, print outs of other Dr's web sites that explain the procedure. No help at all.

A month ago I went to see my Nuerosurgeon and asked again if this could be done and he said that it was a great idea! I asked about all the other times I asked and he said that some procedures take time to make their way to smaller, more rural areas. I told him that I could have easily traveled to where they were doing them....duh!

Anyway, the procedure was amazing. The Dr that did it uses botox in conjunction with EMG (nerve conduction study). With the electrode needle/probe, which is hollow and very thin, he is able to pin point the area of highest spasticity by listening to the sound your muscles/nerves make and inject the botox right then. Other Dr's I guess use real time CT scan and others do it blind. I can tell you that the second he injected the Botox I felt relief. Not 100% relief but way more than the dozens of other injections I have had. Enough relief that I have been sitting up typing for an hour when before I could do that for maybe ten minutes before the pain would get to the maddening state. I just will need a few more injections as he didnt cover the whole area.

Anyway, just wanted to throw this out there for anyone suffering from similar issues. Botox can be used on the back, neck and some muscles in the arms and legs. The procedure I had is called EMG Giuded Botox(r) Injection.

Very interesting thread. My PM doc started doing botox injections about 6 months ago. He is a staff physician and also teaches at a large teaching hosp/med school in my area. I asked him about it, but my spasms are mostly deep torso and it he said it hasn't been proven successful in those areas yet.

I'm curious to see how long it lasts for you. Please keep us posted.
I am curious too! Can I ask what you mean by deep torso? Did he tell you or do you know what "muscle group" is the problem. My Dr went pretty deep into my Rhomboids and I am not a small guy at 6'5 and 270lbs. Im not that over weight, maybe 20lbs, so any intervention into a muscle in deep.

From what I have gone through the last five years in trying to get mine done I would encourage you to research and prove (if you can) that your area is ok to do.

What confuses me about his answer is that he says its not successful. Can he prove that? Are there studies done? Or, is it like with my Dr's, just ignorance and fear. I say ignorance because most people, including many Dr's associate Botox with plastic surgery and cosmetic treatments. I did before I researched it. I know he does injections now but for only 6 months. His experience and scope may be limited. I say fear because Botox is formulated from botulinum toxin and injecting that deeper into the body than the skin seems counterintuitive to most people, including some Dr's.

If there is no risk associated with a procedure and your insurance will pay for it (mine did), I would look elsewhere. What harm could it do? The injection is virtually painless and takes only minutes to do.

I say all this with a certain eagerness. All of us that suffer from pain know that pain management is terribly misunderstood and comes with a lot of prejudices. I found that only when I pressed very hard for treatment, medications and therapies that I got someone to REALLY listen. I played down my conversation I had with my current neurosurgeon in my original post but I will say now that its was a bit heated. He was out of ideas and I had to plead with him to try this. The Dr that did the procedure said to me that he sees it all the time. Im not sure how this relates to your experience but its just my 2 cents.

[QUOTE=cmpgirl;3508164]Very interesting thread. My PM doc started doing botox injections about 6 months ago. He is a staff physician and also teaches at a large teaching hosp/med school in my area. I asked him about it, but my spasms are mostly deep torso and it he said it hasn't been proven successful in those areas yet.

I'm curious to see how long it lasts for you. Please keep us posted.
Thanks Mush,

I have been away for awhile. I gave up fighting and fell into a deep depression where I didnt even want to get out of bed let alone go online. As for the Botox injection, relief can last 4-6 months. It is supposed to really take affect after a week or so. I do know that in my research I saw that it was used in the treatment of migraines. That might be something to look into.

Thanks for the kind words. I posted this because I think its another powerful tool that can be used to treat pain. Will it work for everyone? No. I also posted it because I have come here so many time for help and been treated so well that I wanted to contribute what I could.

Good luck in your research!!!!

Welcome home!!
That is so awesome!!
After you last posted I began to wonder if our conditions were related since I do have pain in my shoulder(as well as my lung pain).
I'm so glad that you have finally found some relief. Is this supposed to last or do you have to go in every so often? I know you're just happy to have any relief. You've certainly been through some tough times. Congrats and enjoy...but don't over do it. I'm going to check out this procedure for myself and hubby.
Thanks for posting. Don't be a stranger.~Mush
Hey Bilbo: My spasms are mostly concentrated in the ilio psoas muscle group (runs down the spine, inside the pelvic wall and into the legs). My doc feels that to get to this area would be difficult and a little more invasive than it was worth) His success rate with muscles that are closer to the fascia has been very high, but not so with those that are farther away from the fascia. And with me, that muscle group has been pretty much destroyed. Unfortunately, before I saw my current PM, I had been being treated (and I use that word loosely) by an incompetant physician, who finally did many pain patients a favor and retired.

I'm in no way saying that botox injections for spasm doesn't work. I'm just saying my doc doesn't feel that I am a good candidate. Believe me, I would be very happy to try it, if it would be beneficial. That was why I asked him about it.

My doc is definitely not ignorant about these things. He is a very highly regarded physician and professor at a medical college. He is always interested in advancements in the field of pain management, and applies them in his practice and his teaching. It is not the practice of this procedure that he is unsure of, it's more about which types of injury or condition that it is beneficial for. Believe me, this man saved my life. He knew about and understood my condition and the root of it, when other doctors had no clue.

I'm truly sorry if I led you to think that I was saying that this procedure was not a valid or effective one. I am very glad that it works for you and for others. I should have been more clear in my post and I apologize if it upset you.

I wish you the very best. God Bless, cmpgirl
Hey cmpgirl,

I think its me that has to apologize. I never thought you didnt think they worked. Im sorry if I gave that impression. The points I was trying to make were:

1) It took me 5 years to get these injections and 4 years to even get a local Dr's to even admit that they existed. With that in mind, there has to be debate on what areas of the body viable to treatment. I did a search for "ilio psoas botox" and got some very credible hits. I didnt read them all, sorry just dont have the time today. I would check them out. One site had an abstract from the European Journal of Neurology and mentions iliopsoas spasticity directly. In fact, many of the sites seem to mention that concept and the use of Botox. So, it seems the area is accessible and the use of botox may be effective according to other Dr's. Maybe the scope of use is different, i.e. MS or cerebral palsy. My point is who cares why your muscles are spastic, if Botox is an option, seek it. I am not trying to say your Dr is wrong but more like that there are other opinions out there.

2) There are different ways that Botox is administered. My Dr uses EMG which is great for easily accessible muscle of the upper back and neck. Some Dr's use real time CT scan to locate the area of concern and use a dye in concert with the Botox to confirm the correct injection location. The CT approach seems like it would be effective in your case.

3) Lastly, in conjunction with #1, I have found that no matter how convincing a medical professional is or how impressive their resume and current work status is, I have learned to never take their opinion as the gospel. Frankly, like the rest of us, Dr's have egos and some are larger than others. Some Dr's dont utilize the medical community as a whole when treating patients. They think that the buck, or knowledge in this case, stops with them. Other Dr's who may be doing treatments that may help you are not even considered. I find this to be a fundamental flaw with our medical system. Not everyone is on the same page and they refuse to be.

I hope that explains where I was coming from. I added some new comments here but its consistent with my frame of mind from the 1st post.

With all that said, I am sad to report that so far my Botox injections have not lived up to my over hyped expectations. They have helped but were not the magic bullet I had unfairly wished for. Like I said in my original post, I know I need more injections in spots higher on my back and possibly my neck.

Hope all is well with you,

Hey Bilbo: I appreciate the info you've given me and I certainly don't feel you need to appologize either. This board is a place where people share what they've learned or experienced and that is one of the reasons that I come here. I totally understand that there are docs out there who have huge egos and don't like to refer or go outside their field where their patients are concerned. As I said in my last post, my first PM was one of them. The doc I see now is definitely not one of them. I've been seeing him for PM for almost eight years and have a great Dr./patient relationship with him. He has referred me to several different specialists over the years and I don't know if you remember from my first post on this thread, he actually does botox injections for muscle spasms.

He just does not feel that I am a good candidate because this muscle group, in my case, has been almost completely destroyed. There really has to be a degree of healthy muscle for these injections to work. He has worked with several types of patients, with varying degrees of muscular damage and/or deterioration and for those with severe to complete damage, he has had very poor results. Maybe if there were other studies done by other doctors that had a higher rate of success, I would consider asking him to give it a try.

I will definitely do some research in that area and if I find statistical data that looks promising, I will bring it to him. I know he would not be offended, because I've brought in info on other treatments in the past and he has always been on board. For the multitude of other trigger points that I have, other modalities, such as myofascial release therapy have worked well for me.

I'm sorry to hear that you haven't gotten the relief you expected, but from what I have read, some cases require multiple injections to do the job. I wish you the best of luck and don't worry, I'm not offended. God Bless, cmpgirl
I somehow missed the part that the muscle group is almost destroyed. I could see how Botox wouldnt be successful. That clears things up. Do you mind me asking if they have diagnosed you with a condition? I ask because I have developed many problems in my spine (see sig) and am starting to have pain in my hips.