Chronic pain can affect nearly every part of a person’s life, but many people delay seeking help or may not realize that additional treatment options are available.
Although Botox is widely known for its cosmetic uses, it can also be used medically to help manage certain chronic pain conditions. During Pain Awareness Month, we spoke with Dr. Guthmiller about his work in anesthesiology and pain management, how Botox treatments work, and what patients can expect when exploring their options. Check out the Q&A below to learn more from Dr. Guthmiller:
I grew up right here in Orange City and was always intrigued by the medical field. During medical school, I took a specific interest in physiology (how the body functions) and the different ways medical conditions alter this. Anesthesiology allows me to see new patients every day in many different situations ranging from surgery and labor and delivery to chronic pain. I feel fortunate to help them through both exciting and potentially difficult situations.
Botox has been used and FDA approved for over 15 years to treat chronic migraines, cervical dystonia, and spasticity. I treat all these conditions here in Orange City. For chronic migraines, Botox mainly works by blocking the nerve signals that cause the pain associated with migraines. For cervical dystonia and spasticity, Botox works by decreasing the strength of overactive muscles leading to less pain and better range of motion.
Cervical dystonia causes overactive and abnormal movement of neck muscles. This can lead to neck pain, head tilting to one side, and tremors. Spasticity is most commonly caused by a neurological disorder such as cerebral palsy or multiple sclerosis but can also be the result from a prior stroke or traumatic brain injury. For both of these disorders, I use either EMG or ultrasound guidance to target the specific muscles causing the pain or limited range of motion. In this way, Botox treatment is tailored to each individual patient depending on their needs.
To be approved for Botox treatment for chronic migraines, you need to have at least 15 days per month with a headache for at least 3 months, and these headaches must last at least 4 hours in duration. You also need to have tried one migraine medication. Asked another way would be, "Do you have 15 completely headache-free days every month?". If the answer is no, then Botox may be beneficial for you.
Botox is a first-line treatment for both cervical dystonia and spasticity and should be considered if you have either of these conditions.
The only contraindication to Botox treatment is an allergy to Botox itself, which is extremely rare.
Botox treatment is done in the clinic and normally only takes 5-10 minutes to complete. It consists of several different injections with a tiny needle just under the skin around the head and neck. Most people start to notice it working within 1-2 weeks with peak effect in the following weeks. Botox lasts for 12 weeks, so I see patients back every 12 weeks for treatment. These follow-up appointments also let us adjust our treatment plan as your pain changes.
One of the most common misconceptions about Botox for chronic migraines is that it will drastically change your appearance. The dosing and areas treated for migraines are different than if you would have Botox for cosmetic purposes. While it is possible that it may lead to fewer wrinkles for some people, that is not the primary goal of this medical treatment.
If you have been diagnosed with cervical dystonia, spasticity, chronic migraines, or if the symptoms I described earlier sound familiar to you, I would encourage you to discuss this with your primary care provider or physical therapist who may refer you over to the pain management clinic. At my initial appointment with you, I will talk to you about your symptoms, discuss potential treatment options, answer any questions you may have, and create a roadmap for the future.
The pain management clinic here at Orange City Area Health System can treat a wide variety of chronic pain conditions that, in the past, people would have had to travel over an hour potentially every few months to get treatment. We feel fortunate to be able to provide these services here in our community.
Living with ongoing pain does not have to mean navigating it alone. If pain is interfering with your daily activities or quality of life, talk with your healthcare provider about an evaluation with our pain management team.