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To botox or not to botox...

Lala329LLala329 Posts: 283
edited 06/11/2012 - 8:45 AM in Spinal Injections
Has anyone had any experience with botox injections??

Trigger point injections give me some relief, but the muscle tightness/spasm/trigger points typically recur after a few weeks. My PM doc says it's because the underlying pain generator that is causing the muscle guarding can't be treated (the cysts), but clearly the myofascial element is a piece of the pain. He said because I get some relief from the trigger point injections it is reasonable to consider botox to extend the relief, and he said it's possible the relief can be long lasting because it breaks up the cycle. He'd be doing the botox only on my painful side, and into the lumbar paraspinals and perhaps a few spots on the QL. Also, I do *not* believe it would be EMG guided which I don't know if that is a big deal or not...

My fear with going forward is that temporarily denervating the muscles will lead to additional problems with muscle weakness and imbalance. I've read conflicting info as to whether or not botox leads to muscle wasting. My PT is not a fan of botox- his idea is to inject the trigger points and then strengthen the muscle. My PM says the muscles aren't functioning properly anyways and they are essentially too tight, so it isn't a problem to paralyze them temporarily to try to break the cycle and get them to ease up and function properly. My thought is that knocking these muscles out could cause other muscles to tighten up and then I'd be in a cycle of needing more and more trigger point injections and botox...

I don't know if I should just be content with the few weeks I get with trigger point injections and let enough be enough, or if this is something to go ahead and pursue...


  • Wow you've done your research. It is so frustrating when your doctor and PT disagree. Many times I have agreed with my PT more in theory. He always takes the time to explain everything so clearly.

    Sounds like there is no definite answer. What about doing a trial? Maybe do one set of injections and work with your PT and see what happens?

    I am so frustrated by the type of pain you are describing. It's hard to figure out if the doctors and PTs are telling you the truth or if they are just looking to draw out your visits for the money. Or are they just taking a shot in the dark because they really don't know what to do.......

    I hope someone can give you better info. And I can't wait to see what others have gone through.
  • To botox or not to botox...

    That is the question?


    Very interesting subject to ponder and research.

    I must admit that I experience MANY moments to where I want to call my Oral Surgeon and have him numb me up good... tossing all caution to the wind. His office is just around the corner for convenience and quick relief. Although he deals solely with the mouth, I always think... "If he can numb my mouth so good, surely he can get that steel thingy out which holds the novacaine and just numb this area, that area, etc." Just the thought of being numbed up during one of my frustrating pain spells...it would be great.

    For me, it's important that my PM doctors, PCP and Physical Therapist agree on my injection treatments. If my PCP has no clue about a proposed injection, I know he would do some research and share his thoughts with me. I value his opinion, as he has known me and my body a lot longer than my other doctors. He knows all that goes on with me and I don't press go... until I get his thumbs up.

    Could you run this by your PCP?

  • I had two botox injections a couple of years ago. A little history-I had a discectomy/lamenectomy about 6 years ago. 6 months post op I was getting into the elevator at work and as I was getting in, the floor rose up, then suddenly dropped. I ended up in a lunging position, kind of like a runners starting position. I immediately felt a burning in the area of my sacrum/coccyx. I went to the ER, they gave me the routine treatment-pain meds, muscle relaxers, etc...This pain and burning continued, I went back to my NS, orthopedic surgeon, rehab doctor, then finally PM. After extensive testing they determined that I had rehernated the area just operated on and I had damaged my piriformis muscle.

    I continued with the conservative treatments, had 3 LESIs, then finally a botox injection. In my case, the botox injection completely eliminated all of my pain coming from the butt and down the leg. The results (I had 2 months apart) lasted about 6 months. That has been the only time during this whole back ordeal, starting with my initial injury, that I felt any longlasting relief. My piriformis muscle was clamping down on the sciatic nerve so when the botox was injected it paralyzed the muscle, therefore relieving pressure on the sciatic nerve. My initial injury happened at home, but after the elevator incident things kept getting progressively worse.

    After the botox injections when the pain started coming back, I asked my PM if he'd do another one. He did some testing and determined that the pain was no longer originating from the muscle, but rather the disc. I've been seeing him and also another PM for a couple of years now and thankfully they tend to catch things early on. Last November I reherniated another area of that same disc but this time a piece of the disc material broke off and migrated down to the S1 nerve root. That was the most pain I have ever been in in my life! Worse than childbirth.

    I do wish that there was an equivalent to botox that could be used on discogenic pain. I'd be first in line for that!

    I think if there is muscle involvement, in my experience, the botox is a godsend. But again, with discogenic pain, I don't think it would be helpful. At least that's what my PM told me. And it does make sense because you really couldn't put any paralyzing agent into the spinal area.

    Good luck and best wishes to you. Pleas PM me if you would like to know anything else about my experience.
  • First and foremost, welcome aboard the Spine-Health family. (I'm generally a regular posting member, but have been out of commission for a couple of months and am trying to catch up with everything). It's nice to meet you. :)

    Thank you for sharing your story with us. I am so glad to hear that you have some great doctors who are taking very good care of you. Some of the injuries you sustained are difficult to diagnose. I see from your signature that you recently had surgery. Hope you are healing well and your pain is being kept to as tolerable a level as possible.

    Question about your botox injections? Were these done under fluoroscope guideance or another type of guideance? What concerns me with what Lala wrote, is that she didn't know for sure if these injections would be the "blind" type or under guideance. For me and the areas I have injected, guideance is vital and I'm leaning towards wanting the same reassurance of proper placement for Lala...if she decides to give the botox a try.

  • Good morning! It's Sunday and so quiet here. Wow. I thought I'd only hear that peace and quiet at my parent's house, but here I am in my own home and it's quiet. I'm about to start making rounds and making sure everyone is breathing :) Just kidding. They're only quiet because they stay up until 4am and sleep until after noon. It'll be a hard adjustment going back to school. But anyway...I'm rambling...

    My botox injections were done under fluoroscopy with a sedative. I personally would NEVER trust a doctor who'd choose to do a botox injection as a "blind stick". The very first LESI was a blind stick. That was the first and only. I quickly found another doctor and everything from there on was done under fluoroscopy.

    My number one question to a doctor doing a botox injection anywhere remotely near the spine would be if they are going to use fluoro. ESIs and botox are way completely different. With a blind stick ESI, they may not get the exact spot they're shooting for, but you can still function afterward. With botox, if they were even to get a tiny bit into an area they're not aiming for, those could have serious consequences.

    On my first botox, under fluoro, my leg was completely numb, like dead numb, for 24 hours. My doctor told me that a tiny bit may have gone into a capillary surrounding that muscle. The second injection went perfectly and I lost no feeling in my legs.

    Good luck to you all!
  • Received first treatment October 17-2013. For server Spasms since Fusion last February after the tumor etc.
    20 injections totaling 400 milligrams , I was told It should start working after 8 days.
    Day 10 I walked further than I had in over a year and a half about a football field with out setting off spasams. Although I had other pain sometimes debilitating , I did not have a single Spasam for the next 12 weeks :) the spasams returned slowly rising in severity until my prescheduled 2nd appointment January 28-2015. My left calf pain that I almost forgot about also returned .500 mil this time with only 10 weeks until next appointment. 4 of these 20 injections caused me pain and tears? Before reaching the parking lot I was in full Spasam and was rushed back to hospital for pain injunction.
    I'm now at day 10 post 2nd Botox injection and having all kinds of problems, Spasams, leg twitching/ myoclonus, tingling in extremities, left calf continuos pain and now my right forearm. I'll try to keep updates coming to this thread. Jury's still out.
  • GeowelshGGeowelsh Posts: 1
    edited 04/03/2015 - 2:01 AM
    C6 sci
    I had botox injected on either side of my crease on the inside of my elbow. 1week later I lost extension in my wrist. This wS my only function I had so now it flops. Will it come back? I hope I didn't lose function permanently.
  • After the additional problems from 2nd treatment particularly my right forarm I decided to not go back for 3rd treatment.
    But, here at the 3 month mark since last treatment I'm having spasms again daily.
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