• BOTOX^® Anecdote

Martin K. Childers, DO

Many clinician first beginning to use BOTOX^® in the treatment of pain syndromes find that the use of this emerging treatment in their practice attracts new, unexpected patients to the clinic. For example, many individuals develop painful spasticity (spasms of muscle) in the upper limb following a stroke. The typical scenario is the patient who presents to the pain management specialist with a "fisted hand" syndrome, which often remains problematic for even the most skilled clinician. In this painful condition, flexor muscles of the fingers and wrist contract involuntarily, causing skin problems of the palm, and eventually contribute to contractures.

In my practice, I have successfully treated the painful fisted hand with BOTOX^® injections, a long-acting neuromuscular blocking agent. The difficulty for new BOTOX^® injectors is in locating the correct muscles to treat, and in finding the optimal site to inject. In my opinion, audio EMG or motor point localization should be used for this purpose. However, not every clinician is skilled or comfortable using such equipment.

When I was lecturing in Sweden, a physiotherapist demonstrated a alternative method to find motor points in surface muscles (like the finger flexors) easily and quickly:

A TENS unit can be used to localize the surface motor point over a muscle quite easily: attach one surface electrode onto the patient’s skin, and the other electrode on the back of your own hand. Use a little electrode gel or water and gently run your index finger over the surface of the skin overlying the muscle of interest. Adjust the intensity of the TENS unit until you can actually feel the current beneath your finger, then, decrease the stimulus intensity until you no longer can feel any current except for one point on the skin. This point will correspond to the motor point found using the more traditional technique. If you like, you can verify this by increasing the TENS intensity high enough to elicit a muscle contraction over the tip of your finger!
SPPM Note: For more in depth information, please refer to the recent  publication written by Dr. Childers, Use of Botulinum Toxin Type A in Pain Management   A synopsis is on the book page of this web site.  A review will be forthcoming.

• Botox Injections for TMJ
     Temporomandibular joint disorder, TMJ, affects approximately 10% of the population in the United States.  This painful disease causes pain around the ears, headaches, and often neck pain.  Orthotic mouthpieces to prevent grinding of the jaw and teeth, medication, such as antidepressants, and physical therapy are the standard treatment.  A nerve block of the temporomandibular joint is often efficacious in relieving this painful condition.
      In a recent study with 46 patients, Dr. Brian Freund and Dr. Marvin Schwartz have confirmed that injection of purified Botulinum toxin (Botox) is effective in treating TMJ cases that are resistant to other forms of treatment.  "The Botox injections produced a statistically significant improvement in all five measured outcomes-pain, function, mouth opening, tenderness to palpation and bite force, " states Dr. Freund.  Institute for Head and Neck Therapy, Pickering, Ont., Oct. 19, 1998.
  Special Note:  Lectures on the medical use of Botulinum Toxin are given at the SPPM meetings.  For more information visit the meeting page

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