The Hidden Talents of BOTOX®
Written by Rebecca Budde • Photography by Jason Johnson
BOTOX® entered the national consciousness as a beauty treatment to banish wrinkles, but now medical science is discovering its effectiveness to help people with chronic pain. From clinical trials to life-changing surgery, SIU’s Institute for Plastic Surgery is leading the way.
For some, the cold winter months mean the welcome possibility of a dusting of snow on the lawn and icicles hanging from rooftops. For others, like Robin Brinkmeier, 58, the cold can exacerbate an already painful, incurable condition.
Diagnosed with Raynaud’s disease seven years ago, Brinkmeier takes precautions in the cold months. She must wear gloves, and her toes get so cold and loose blood so quickly that she wraps her toes individually in an attempt to keep them warm. She buys her shoes one size larger to accommodate her extra layers.
Raynaud’s disease is a spastic disorder of the blood vessels. Brought on by cold, vibration or stress, the blood vessels constrict, decreasing the blood flow to the extremities. Raynaud’s typically affects the fingers, though it can also affect the toes. The decreased blood flow leads to pallor, cold and painful extremities. Eventually painful ulcers can form and may lead to amputation.
In January 2004, Michael Neumeister, MD, SIU’s chair of the Department of Surgery and the Institute for Plastic Surgery and the Elvin G. Zook, MD Endowed Chair in Plastic Surgery, injected his first patient with BOTOX® in an attempt to help his pain. "His fingers were white with no blood supply and he had some ulcers and exposed bone," Dr. Neumeister says. "The first time he came to me, he said, ‘Doc, cut my fingers off!’ This man had been admitted to the hospital, had intravenous morphine and even surgeries to attempt to open up the blood vessels."
One injection and the patient was pain-free in minutes. Since that first injection, BOTOX® has started to become a more widely known option. The FDA has not given on-label approval for using BOTOX® for Raynaud’s, but Dr. Neumeister is conducting a stage 2 clinical trial. Brinkmeier has enrolled in the trial and hopes that her pain is eliminated from the BOTOX®.
The side effects are minimal, but the reduction of the patient’s pain is almost immediate. Patients may experience temporary (a couple of months) weakness in the muscles that control the spreading of the fingers.
In addition to patients with Raynaud’s, Dr. Neumeister has used BOTOX® to treat neuromas, painful scars, chronic back pain, carpal tunnel, tennis elbow, diabetic foot pain and reflex sympathetic dystrophy syndrome. 70 percent of patients have pain relief, according to Dr. Neumeister.
Botox is also being used by plastic surgeons as a powerful weapon against migraine headaches.
Christina Tribbett, 37, of Creve Coeur, Ill., began experiencing severe migraine headaches in 2002. The debilitating pain for the single mom of two boys landed her in OSF St. Francis Medical Center’s emergency room in Peoria an average of three days a week. The illness caused her to quit her job. "It was horrible to watch and not be able to do anything to help her,” says Tribbett’s mother, Rebecca Burroughs.
After trying multiple medications and therapies, her neurologist, Dennis Q. McManus, MD, an ’87 SIU internal medicine resident alumnus, told her about the use of BOTOX® to help fight the pain of migraines. By injecting the offending muscle with BOTOX®, the muscle becomes paralyzed and unable to compress the nerves causing the headaches.
The FDA has approved the use of BOTOX® to help those who suffer from the pain of certain migraine headaches, but it is reserved for those with severe cases. To qualify for BOTOX® injections for migraines, patients must suffer from debilitating migraines at least 15 days a month, keep a diary of all symptoms and have them documented by their physician.
Tribbett received the BOTOX® injections three times, in approximately three-month intervals. Though the BOTOX® worked for the pain, she says that when the last round wore off, the headaches were back and more aggressive than before. The good news was that because the BOTOX® worked for Tribbett, surgery to permanently eliminate the headaches was an option. "Surgeons can use BOTOX® as a diagnostic tool,” Nicole Sommer, MD, SIU associate professor of plastic surgery, says. "If it works well for the migraine pain, in the specific area that’s a problem, there’s an 80-90% chance that nerve decompression surgery will successfully eliminate the migraines.” Dr. Sommer is the only surgeon in Springfield offering this life-changing surgery.
Once the surgeon determines the specific trigger point of the pain, migraine surgery is usually performed on an outpatient basis with the patient under sedation and/or general anesthesia. The surgical technique varies depending on the trigger point. A nerve may be removed or in other cases, a small portion of muscle pinching a cranial nerve may be removed.
Because Tribbett’s headaches were triggered in multiple locations and were so severe, she had to have two surgeries. Tribbett says she occasionally has minor headaches now, but she knows when they’re coming on. "I can treat them with just an Advil® now,” she says.
Burroughs says it’s great to see her daughter back to being herself again. "The surgery validated that there really was a physical problem. That was such a blessing.” Another side effect of BOTOX® is optimism. "I’m so excited for those who will follow me,” says Tribbett. "Hope is an incredible gift, and this discovery offers great hope to those who are suffering.” The many talents of BOTOX® will continue to be evaluated to help those who battle chronic pain.