Thursday, August 23, 2007

Botulinum Neurotoxin (Botox) for pain management

I recently co-authored a chapter on Piriformis Syndrome in a new text by Grant Cooper, titled Therapeutic Uses of Botulinum Neurotoxin,
Piriformis Syndrome refers to an irritation of the sciatic nerve in the buttock, which differs from a herniated disc in the spine.

After injecting many a forehead with botox, Plastic Surgeons learned that patient's headaches were alleviated. Through research, we have learned that botox works by temporarily weakening overworked muscles. Also, we now understand that Botox inhibits pain (nociceptive) fibers as well.

Botox is a purified form of Botulinum Neurotoxin type A that allows physicians to inject a small quantity into a specific area with a local response. In my residency training in New York City; we safely treated hundreds of adults with Stroke & children with Cerebal Palsy suffering from spasticity. "Spasticity" refers to muscle tightness (an increased reflex) after a brain injury. People with spasticity may have an elbow uncontrollably bent, thumb clenched inside a palm, or pointed feet with difficulty walking. We have seen dramatic functional benefits with return of independence; however the effects last approximately 3 months and need to be repeated periodically.

There is optimism that Botox may help alleviate knee osteoarthritic pain. A recent pilot study from Minnesota, showed decreased pain in patients with continued pain following knee replacements.
However, further research is certainly needed.

Sunday, August 19, 2007

Doctor Heal Thyself or How I Treated My Own Tendon Injury

After moving to California recently, I decided to take surfing lessons. However, I wasn't aware that I was about to receive a PRP injection myself after spraining my MCL on the first day! I felt a pop in my knee and subsequently had an MRI that showed bruising of my tibia & swelling/fluid at my MCL. Shortly afterwards, I received a PRP injection to my knee.

This experience let me understand the healing process & better communicate the recovery process with patients. Most importantly I have appreciated the necessary role of Physical therapy post injection. We are in the process of developing Physical therapy protcols to maximize positive outcomes & improve pain tolerance. Being a typical doctor, and not properly taking care of myself, I worked the day after my injection rather than resting as I recommend to others. This resulted in increased pain which was later relieved with a device I received called "game Ready" which provides cooling & compression with ice. Now, I describe the process as similar to experiencing a new injury. Although there isn't a second injury, we are releasing potent proteins/growth factors that normally accumulate when there is an acute injury.

I tell patients that they may feel a different pain which gradually subsides in 2-7 days. For some reason patient tolerance of the injection varies. Some describe significant brief discomfort, while others are completely fine.

Platelet Rich Plasma Introduction

This blog site was created to establish a non-competitive forum for physicians performing PRP treatments & for patients interested in learning more about this emerging treatment. I was introduced to this treatment by my colleagues, Dr Bert Mandelbaum & Dr Michael Gerhardt; who are premiere orthopaedists responsible for treating numerous soccer athletes from all over the world. PRP is being used by many European professional soccer clubs, and is now making it's way to the U.S.

Initially we injected a few professional soccer athletes for MCL tears/sprains and noted accelerated recovery & earlier than expected return to play. Click link to see article:

Shortly afterwards we began treating weekend warriors with chronic non-healing tendon injuries including tennis/golfers elbow, achilles tendonosis, patellar tendonosis (jumpers knee). After a favorable response from patients and following discussions with other leaders in the community on PRP, we are now injecting PRP for other non-healing injuries including knee arthritis & hip bursitis.

PRP provides a safe and natural alternative to surgery using the body's natural ability to heal itself.