Botox therapy for ischemic digits

Michael W. Neumeister, Christopher B. Chambers, Margo S. Herron, Kelli Webb, Joel Wietfeldt, Jessica N. Gillespie, Rueben A. Bueno, Carisa Miller Cooney

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Treating patients with Raynaud's phenomenon who have chronic pain and ulcerations is extremely challenging. Unrelenting pain can lead to dysfunction and disuse, rendering the patient debilitated and/or chronically depressed. Pharmacologic vasodilators and surgical sympathectomies offer variable benefits. Outcomes of symptomatic patients treated with botulinum toxin type A (Botox) injections for Raynaud's phenomenon are presented. METHODS: A retrospective study focused on patient outcomes was performed on 19 patients diagnosed with Raynaud's phenomenon. Patients suffered from chronic ischemic hand pain. All patients had vascular studies to rule out occlusive disease. Fifty to 100 units of Botox were injected into the palm around each involved neurovascular bundle. Preinjection and postinjection laser Doppler scanning was performed on most patients to measure blood flow. RESULTS: Sixteen of 19 patients (84 percent) reported pain reduction at rest. Thirteen patients reported immediate relief; three reported more gradual pain reduction over 1 to 2 months. Three patients had no or minimal pain relief. Tissue perfusion results demonstrated a marked change in blood flow (-48.15 percent to 425 percent) to the digits. All patients with chronic finger ulcers healed within 60 days. Most patients [n = 12 (63 percent)] remained pain-free (13 to 59 months) with a single-injection schedule. Four patients (21 percent) required repeated injections because of recurrent pain. CONCLUSIONS: Vascular function is abnormal in patients with Raynaud's phenomenon. Although its mechanism is unknown, Botox yielded a distinct improvement in perfusion and reduction in pain in patients failing conservative management. Continued research may lead to more specific and reliable treatment for Raynaud's patients.

Original languageEnglish (US)
Pages (from-to)191-200
Number of pages10
JournalPlastic and Reconstructive Surgery
Volume124
Issue number1
DOIs
StatePublished - Jul 2009
Externally publishedYes

Fingerprint

Raynaud Disease
Pain
Therapeutics
onabotulinumtoxinA
Injections
Blood Vessels
Perfusion
Type A Botulinum Toxins
Sympathectomy
Vasodilator Agents
Chronic Pain
Fingers
Ulcer
Appointments and Schedules
Lasers
Retrospective Studies
Hand
Research

ASJC Scopus subject areas

  • Surgery

Cite this

Neumeister, M. W., Chambers, C. B., Herron, M. S., Webb, K., Wietfeldt, J., Gillespie, J. N., ... Cooney, C. M. (2009). Botox therapy for ischemic digits. Plastic and Reconstructive Surgery, 124(1), 191-200. https://doi.org/10.1097/PRS.0b013e3181a80576

Botox therapy for ischemic digits. / Neumeister, Michael W.; Chambers, Christopher B.; Herron, Margo S.; Webb, Kelli; Wietfeldt, Joel; Gillespie, Jessica N.; Bueno, Rueben A.; Cooney, Carisa Miller.

In: Plastic and Reconstructive Surgery, Vol. 124, No. 1, 07.2009, p. 191-200.

Research output: Contribution to journalArticle

Neumeister, MW, Chambers, CB, Herron, MS, Webb, K, Wietfeldt, J, Gillespie, JN, Bueno, RA & Cooney, CM 2009, 'Botox therapy for ischemic digits', Plastic and Reconstructive Surgery, vol. 124, no. 1, pp. 191-200. https://doi.org/10.1097/PRS.0b013e3181a80576
Neumeister MW, Chambers CB, Herron MS, Webb K, Wietfeldt J, Gillespie JN et al. Botox therapy for ischemic digits. Plastic and Reconstructive Surgery. 2009 Jul;124(1):191-200. https://doi.org/10.1097/PRS.0b013e3181a80576
Neumeister, Michael W. ; Chambers, Christopher B. ; Herron, Margo S. ; Webb, Kelli ; Wietfeldt, Joel ; Gillespie, Jessica N. ; Bueno, Rueben A. ; Cooney, Carisa Miller. / Botox therapy for ischemic digits. In: Plastic and Reconstructive Surgery. 2009 ; Vol. 124, No. 1. pp. 191-200.
@article{37758a6045994a4d968f4ad50ac98cdb,
title = "Botox therapy for ischemic digits",
abstract = "BACKGROUND: Treating patients with Raynaud's phenomenon who have chronic pain and ulcerations is extremely challenging. Unrelenting pain can lead to dysfunction and disuse, rendering the patient debilitated and/or chronically depressed. Pharmacologic vasodilators and surgical sympathectomies offer variable benefits. Outcomes of symptomatic patients treated with botulinum toxin type A (Botox) injections for Raynaud's phenomenon are presented. METHODS: A retrospective study focused on patient outcomes was performed on 19 patients diagnosed with Raynaud's phenomenon. Patients suffered from chronic ischemic hand pain. All patients had vascular studies to rule out occlusive disease. Fifty to 100 units of Botox were injected into the palm around each involved neurovascular bundle. Preinjection and postinjection laser Doppler scanning was performed on most patients to measure blood flow. RESULTS: Sixteen of 19 patients (84 percent) reported pain reduction at rest. Thirteen patients reported immediate relief; three reported more gradual pain reduction over 1 to 2 months. Three patients had no or minimal pain relief. Tissue perfusion results demonstrated a marked change in blood flow (-48.15 percent to 425 percent) to the digits. All patients with chronic finger ulcers healed within 60 days. Most patients [n = 12 (63 percent)] remained pain-free (13 to 59 months) with a single-injection schedule. Four patients (21 percent) required repeated injections because of recurrent pain. CONCLUSIONS: Vascular function is abnormal in patients with Raynaud's phenomenon. Although its mechanism is unknown, Botox yielded a distinct improvement in perfusion and reduction in pain in patients failing conservative management. Continued research may lead to more specific and reliable treatment for Raynaud's patients.",
author = "Neumeister, {Michael W.} and Chambers, {Christopher B.} and Herron, {Margo S.} and Kelli Webb and Joel Wietfeldt and Gillespie, {Jessica N.} and Bueno, {Rueben A.} and Cooney, {Carisa Miller}",
year = "2009",
month = "7",
doi = "10.1097/PRS.0b013e3181a80576",
language = "English (US)",
volume = "124",
pages = "191--200",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Botox therapy for ischemic digits

AU - Neumeister, Michael W.

AU - Chambers, Christopher B.

AU - Herron, Margo S.

AU - Webb, Kelli

AU - Wietfeldt, Joel

AU - Gillespie, Jessica N.

AU - Bueno, Rueben A.

AU - Cooney, Carisa Miller

PY - 2009/7

Y1 - 2009/7

N2 - BACKGROUND: Treating patients with Raynaud's phenomenon who have chronic pain and ulcerations is extremely challenging. Unrelenting pain can lead to dysfunction and disuse, rendering the patient debilitated and/or chronically depressed. Pharmacologic vasodilators and surgical sympathectomies offer variable benefits. Outcomes of symptomatic patients treated with botulinum toxin type A (Botox) injections for Raynaud's phenomenon are presented. METHODS: A retrospective study focused on patient outcomes was performed on 19 patients diagnosed with Raynaud's phenomenon. Patients suffered from chronic ischemic hand pain. All patients had vascular studies to rule out occlusive disease. Fifty to 100 units of Botox were injected into the palm around each involved neurovascular bundle. Preinjection and postinjection laser Doppler scanning was performed on most patients to measure blood flow. RESULTS: Sixteen of 19 patients (84 percent) reported pain reduction at rest. Thirteen patients reported immediate relief; three reported more gradual pain reduction over 1 to 2 months. Three patients had no or minimal pain relief. Tissue perfusion results demonstrated a marked change in blood flow (-48.15 percent to 425 percent) to the digits. All patients with chronic finger ulcers healed within 60 days. Most patients [n = 12 (63 percent)] remained pain-free (13 to 59 months) with a single-injection schedule. Four patients (21 percent) required repeated injections because of recurrent pain. CONCLUSIONS: Vascular function is abnormal in patients with Raynaud's phenomenon. Although its mechanism is unknown, Botox yielded a distinct improvement in perfusion and reduction in pain in patients failing conservative management. Continued research may lead to more specific and reliable treatment for Raynaud's patients.

AB - BACKGROUND: Treating patients with Raynaud's phenomenon who have chronic pain and ulcerations is extremely challenging. Unrelenting pain can lead to dysfunction and disuse, rendering the patient debilitated and/or chronically depressed. Pharmacologic vasodilators and surgical sympathectomies offer variable benefits. Outcomes of symptomatic patients treated with botulinum toxin type A (Botox) injections for Raynaud's phenomenon are presented. METHODS: A retrospective study focused on patient outcomes was performed on 19 patients diagnosed with Raynaud's phenomenon. Patients suffered from chronic ischemic hand pain. All patients had vascular studies to rule out occlusive disease. Fifty to 100 units of Botox were injected into the palm around each involved neurovascular bundle. Preinjection and postinjection laser Doppler scanning was performed on most patients to measure blood flow. RESULTS: Sixteen of 19 patients (84 percent) reported pain reduction at rest. Thirteen patients reported immediate relief; three reported more gradual pain reduction over 1 to 2 months. Three patients had no or minimal pain relief. Tissue perfusion results demonstrated a marked change in blood flow (-48.15 percent to 425 percent) to the digits. All patients with chronic finger ulcers healed within 60 days. Most patients [n = 12 (63 percent)] remained pain-free (13 to 59 months) with a single-injection schedule. Four patients (21 percent) required repeated injections because of recurrent pain. CONCLUSIONS: Vascular function is abnormal in patients with Raynaud's phenomenon. Although its mechanism is unknown, Botox yielded a distinct improvement in perfusion and reduction in pain in patients failing conservative management. Continued research may lead to more specific and reliable treatment for Raynaud's patients.

UR - http://www.scopus.com/inward/record.url?scp=68249128112&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68249128112&partnerID=8YFLogxK

U2 - 10.1097/PRS.0b013e3181a80576

DO - 10.1097/PRS.0b013e3181a80576

M3 - Article

VL - 124

SP - 191

EP - 200

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 1

ER -