Tips For Dealing With Chronic Pain
Chronic pain is one that last more than 3-6 months , or pain that extends behind the expected period of healing. This blog post explains the different types of pain caused by Parkinsons disease and how to address pain brought on by the disease, by medications, or by comorbid disease. It is always best to treat pain before it becomes chronic.
Botulinum Toxin Type B For Dystonia
Myobloc was approved by the FDA in December 2000 for treatment of patients with cervical dystonia to reduce the severity of associated abnormal head position and neck pain. BTX-B also has received marketing authorization from the European Union’s Committee for Proprietary Medicinal Products and will be marketed as Neurobloc .
Reported clinical studies have shown Myobloc/Neurobloc to be a safe and effective treatment for cervical dystonia in patients who have responded to BTX-A and in those who developed resistance to BTX-A. As with all the botulinum toxins, BTX-B acts at the neuromuscular junction inhibiting the release of ACh at the presynaptic membrane however, the primary mechanism of action of BTX-B differs from that of BTX-A, as BTX-B inactivates a different protein involved in the release of ACh.
In a multicenter study of 100 patients with cervical dystonia, Jankovic et al examined the immunogenicity of botulinum toxin type B . They correlated the clinical response with the presence of blocking antibodies using a novel mouse protection assay. One-third of the patients who were negative for BTX-B Abs at baseline became positive for BTX-B Abs at last visit, suggesting that the high antigenicity of BTX-B limits its long-term efficacy.
Offer Patients More Hope
Rest tremors are among the most obvious symptoms of PD and often occur early in the diseases progress. When you train at Dentox, you learn about both medical and cosmetic uses of Botox to help patients get the results they need. Reach out now or sign up for Dentox injectables training and get the skills to give patients additional hope while also increasing your practices profits.
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Pain Management In Patients With Parkinsons Disease: Challenges And Solutions
This review focuses on the diagnosis and management of Parkinson-related pain. It reviews the incidence and prevalence of PD, general pain and PD-related pain, the pathophysiological pathways of pain in PD, physiological pathways of pain relief, measurements of pain, clinical diagnosis of PD-related pain, and treatment strategies.
Movement Disorders Centers Of Excellence At Northwestern Memorial Hospital
The Northwestern Medicine Parkinson’s Disease and Movement Disorders Center at Northwestern Memorial Hospital provides innovative, multidisciplinary care for patients and families affected by Parkinson’s disease and other movement disorders.
The Center’s care team works to promote health, education and support for patients. It also supports caregivers, family members, healthcare providers and the community. The Center also conducts pre-clinical and clinical research in order to extend the knowledge and treatment of movement disorders.
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Preparation Of Botulinum Toxin For Injection
The toxin is produced by the gram-negative anaerobic bacterium Clostridium botulinum. It is harvested from a culture medium after fermentation of a toxin-producing strain of C botulinum, which lyses and liberates the toxin into the culture. The toxin is then extracted, precipitated, purified, and finally crystallized with ammonium sulfate. BTX-A should be diluted with preservative-free saline and the preparation used within 4 hours of reconstitution. Conditions for the stability of the toxin in solution include pH 4.26.8 and temperature less than 20 degrees Celsius. Crystallized toxin is inactivated quickly in solution by shaking.
Biological activity of the BTX-A distributed by Allergan Inc. onabotulinumtoxin A is different from that of the BTX-A produced by Speywood Pharmaceuticals in England abobotulinumtoxinA or Japan. The potency of BTX is expressed as mouse units, with 1 mouse unit equivalent to the median lethal dose for mice. BOTOX® is dispensed in small vials containing 100 units , while a vial of Dysport contains 500 U. The relative potency of BOTOX® units to Dysport units is approximately 1:3. BOTOX® units are used throughout this article. Most physicians dilute the vial of BOTOX® with 1-4 mL of saline, for a concentration of 2.5-10 U/0.1 mL.
What Causes Speech And Swallowing Difficulties Associated With Parkinsons
There are multiple reasons why Parkinsons can lead to speech and swallowing difficulties. For example:
- Parkinsons affects the muscles and nerves in your face, throat, mouth, tongue, respiratory system, and larynx. As these muscles and nerves weaken, you might have more speaking and swallowing difficulties.
- Parkinsons makes it difficult for your muscles to activate. This includes the muscles you need to speak and swallow, such as your throat, tongue, and larynx.
- Parkinsons affects the areas of your brain that control the speech process.
- Parkinsons changes the way your brain processes information. This can make it difficult to be part of conversations and communicate your thoughts.
- Parkinsons can cause your movements to become smaller and less powerful. This includes the movements you make with your mouth and throat that affect speech and swallowing.
- Parkinsons can reduce your sensory awareness. You might not realize that the volume, speed, or pitch of your voice has changed. You might feel that you are shouting even when you are speaking at a normal volume.
- Parkinsons can reduce your ability to prompt your own outward speech and begin conversations. Often, people with Parkinsons who are able to answer questions or respond to others have difficulty voicing thoughts without being asked.
Speech therapy can benefit people with Parkinsons.
Speech and language therapists are healthcare professionals who can work with patients to help improve:
- communication
- swallowing
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How Does Botox Work
Usually, a message gets transmitted from the nerve to the muscle by release of the chemical acetylcholine from the nerve endings. When Botulinum toxin is injected into a muscle, it gets taken up by the nerve endings that interface with the muscle, and interferes with the release of acetylcholine, thereby stopping communication between the nerve and the muscle. When this communication is decreased, the muscle is weakened and certain Parkinsons symptoms are lessened.
How To Deal With The 6 Common Causes Of Leg Pain In Pd
Severe leg pain is a common complaint from people with PD. Lately, it is understood that central pain is common to Parkinsons disease, and can even be the first sign of PD, usually bilaterally. This blog post lists six causes of lower limb pain, and the importance of treating it. Treatments depend on properly identifying the source of pain. Some treatment suggestions are included.
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Uses Of Botulinum Toxin In Parkinsons Disease
You most likely know that Botulinum toxin is used for cosmetic purposes to decrease wrinkles. Prior to being used in this way, Botulinum toxin was used for medical purposes to control abnormal movements. In the right hands, it can be a very effective measure to control a variety of problems related to PD.
Opening The Medicine Box In The Mind: The Psychology Of Pain
In this 50-minute lecture, Beth Darnall, PhD explains how our experience of pain goes beyond the physical sensation of pain. It has emotional and psychological components that affect our ability to treat pain. She cites research to demonstrate that and shares 13 specific tips to reduce the experience of pain and increase treatment effectiveness. Audience questions follow the lecture.
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Different Types Of Botulinum Toxin
There are eight different botulinum toxin species that occur in nature. There are only two however, that are produced commercially Botulinum toxin A and B.
The commercially available products are:
Each of the above agents are FDA approved for a slightly different list of clinical indications.
My Parkinson’s Story: Pain
This 10-minute video alternates between an interview with a man and and doctors. The man shares his experience with pain as a symptom of Parkinson’s disease. The doctors explain that pain is common in Parkinson’s disease, often due to rigidity or dystonia, which can be exacerbated by “off” periods. Pain caused by Parkinson’s symptoms can be relieved by Parkinson’s medications, exercise, DBS and botox injections. Pain is an invisible symptom that should be mentioned to your neurologist.
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What Does Botulinum Toxin Treatment For Parkinsons Look Like
The effects of Botulinum toxin take hold about 3-10 days after the injections and last approximately three to four months, so the treatments typically need to be repeated on a regular basis. Although this means routine injections, it also means that Botulinum toxin injections do not have any permanent side effects. Some side effects may still occur with Botulinum toxin injections and the doctor who performs the procedure will review these with you. An advantage of using Botulinum toxin for the treatment of the conditions noted above, is that the toxin typically only impacts the areas into which it is injected, as opposed to oral medications which have a more widespread effect, and therefore more potential for side effects.
Nationally Recognized Quality Of Care
- U.S. News & World Report ranks Northwestern Memorial Hospital in the top 10 for neurology and neurosurgery.
- Northwestern Memorial Hospital is the only hospital to offer three designated Centers of Excellence for movement disorders, including Parkinson’s disease, Huntington’s disease, and Wilson disease.
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Revisiting Pain In Pdthe 50 Shades Of Pain Experienced By Parkinsons Patients
Pain is a quality of life issue for people with Parkinsons disease and can be under treated by doctors who may assume that is worsens as the disease progresses, although for some pain is an initial symptom of PD. This article helps focus your physicians attention in the right direction to accurately diagnose your pain.
Research And Clinical Trials
OHSU scientists have long been at the forefront of research into Parkinsons disease. Over the years, we have played a role in every major development in Parkinsons care. Our work includes:
Clinical trials: The OHSU Brain Institute offers clinical trials for patients with varying stages of Parkinsons disease. We have research happening across many sites, so if you qualify, you may not need to travel to Portland to take part.
Parkinsons disease: We are conducting research on psychological and physical aspects of Parkinsons, including:
- How stress affects the progression of the disease.
- Ways to slow the breakdown of dopamine, a brain chemical that plays a central role in Parkinsons.
- The role of protein buildup, with the goal of developing and testing a new medication.
Balance Disorders Laboratory: Researchers in our Balance Disorders Laboratory are exploring the connection between motor signals and balance to develop rehabilitation approaches.
Improving deep brain stimulation devices: DBS uses open-loop devices, which deliver constant stimulation even if symptoms are absent. Were exploring a closed-loop device to provide stimulation only as needed.
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Pain In Parkinsons Disease: A Spotlight On Women
This 2-page interview with neurologist, Dr. Jori E. Fleisher, discusses pain in Parkinsons disease with some interesting statistics about women and pain. Dr. Fleisher outlines the 4 primary types of pain in PD, how depression interferes with pain management, the role of exercise and medications in pain management as well as alternative therapies.
Complications With Particular Clinical Applications
See the list below:
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Ten percent of patients develop ptosis, which improves spontaneously in less than 2 weeks.
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Other complications include blurring of vision, tearing, and local hemorrhage.
Cervical dystonia
The most common adverse effects include neck weakness , dysphagia , and local pain. The occurrence of dysphagia appears to be related to the dose and the muscles injected.
Adverse effects are transient and usually resolve spontaneously within 2-3 weeks.
Oromandibular dystonia
Adverse effects are uncommon and include dysphagia and pain at the injection site.
Allam et al support the view that executive dysfunction in primary cranial dystonia is secondary to the disrupting effects of the symptoms. Treatment with BTX alleviates the symptoms and, consequently, improves sustained attention.
Laryngeal dystonia
Swallowing difficulties, which can last for 3-7 days, occur in 60% of patients.
Transient hypophonia and stridor also have been reported.
Hemifacial spasm
Adverse effects depend on location of injection.
Lower face injections may result in facial weakness and asymmetry, face and mouth droop, drooling, and loss of facial expression. Forehead injections can result in brow ptosis or loss of eyebrow elevation.
References
Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013 Jun 15. 28 :863-73. .
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Advanced Procedures And Technology
Deep Brain Stimulation
When symptoms are progressing and becoming more difficult to manage, advanced surgical procedures like deep brain stimulation may be appropriate. DBS delivers high-frequency electrical stimulation to precise areas of the brain, minimizing the brain signals that result in tremors, stiffness, slowness and extra movements caused by Parkinsons disease, essential tremor and dystonia. It can offer many benefits, including the need to take less medication and therefore experience fewer medication side effects. Northwestern Medicine performs more DBS surgeries than any other health system in Illinois.
Botulinum Toxin
Botulinum toxin is a highly effective treatment for symptoms related to many movement disorders. Patients with abnormal arm, leg, or trunk positions, or one of various other movement disorders such as dystonia, blepharospasms, or hemifacial spasm may have dramatic benefit with proper injections. Botulinum toxin injections may also be used to treat excessive drooling, chronic migraines headaches, and spasticity.
Does Botox Work For Hand Tremors
Botox injections have been useful in the treatment of hand tremors for some patients. The toxin must be placed directly into the target muscles and repeated every three months in order for the effects to last. If youre not sure how many units of botox for hands is needed, it varies on the person and severity of the case. Majority of patients receive between 25-75 units of Botox per hand.
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Botox Treatment For Essential Tremor
Most of us are familiar with botoxthe drug that doctors have been using for years to reduce the appearance of wrinkles and fine lines on people of all ages. But did you know that botox isnt just for cosmetic purposes? Botox can actually be used for a lot of health applications, such as treating essential tremor . Botox is a common method of treatment for essential tremor as it can help to alleviate symptoms.
In this article, we will discuss what exactly botox is, how botox can help essential tremor, botox facts, and more. Living with tremors is frustrating, especially if it impacts your daily life, so finding a solution is crucial. And botox might be just that.
Am I A Good Candidate For Botulinum Toxin For Movement Disorders
You may be a good candidate for botulinum toxin injections if you are at least 18 years old and have been diagnosed with one of the conditions above.
Although this drug is technically a toxin, it is generally safe and effective when used in correct dosages by trained providers. The most common side effect is temporary muscle weakness near injection sites. You may also experience pain, bruising, or bleeding at the injection sites. Rarely, it can cause generalized weakness or flu-like symptoms.
You should not take botulinum toxin if you:
- Are allergic to any of its ingredients or have had an allergic reaction to another botulinum toxin product
- Are pregnant
- Have a neuromuscular condition or myasthenia gravis)
- Have Lambert-Eaton syndrome
Tell your doctor about all of your medical conditions and medications during your evaluation for Botox therapy.
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Botox For Rest Tremor: Another Alternative For This Parkinsons Symptom
Rest tremor is a Parkinsons disease symptom that happens when muscles of the hands, arms or legs are relaxed. In many cases, the fingers or hands are the only parts of the body impacted. The condition is associated with altered activity in two brain circuits: the basal ganglia, which are impacted by the depleted dopamine levels associated with PD, and the cerebello-thalamo-cortical circuit.
Botox for rest tremor is an alternative to medications that may or may not work. This condition is a stubborn sign of PD that often doesnt respond to treatment, so patients may have to try more than one approach to see symptom reduction.
What Is Botulinum Toxin
Botulinum toxin is a substance produced by the bacteria Clostridium botulinum. Botulism is caused by the harmful effects of this toxin. If the toxin enters the bloodstream, it can spread throughout the body, causing widespread muscle weakness. In its full-blown form, botulism can cause difficulty with swallowing and breathing by causing weakness of the muscles that control these functions.
The good news is that decades ago, scientists learned how to isolate the toxin and harness its power for medical use, and it can be safely injected into particular muscles in order to decrease unwanted movements of those muscles.
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Side Effects Of Using Botox
In general, side effects of Botulinum toxin can be due to over-weakening of the injected muscle, which, if done on leg and foot muscles, for example, could interfere with walking.
Uncommonly, Botulinum toxin can diffuse to neighboring muscles and cause more widespread side effects. For example, injections of neck muscles could result in toxin diffusing locally to muscles used for swallowing and cause difficulty swallowing. Even less common, are side effects due to travel of the toxin to more distant parts of the body via the bloodstream. For example, injections of any body part could theoretically result in difficulty swallowing or breathing if the toxin travels to these muscles. This is very rare however and Botulinum toxin injections are typically very safe. The full risk profile for your particular situation however, needs to be discussed with the physician performing the injections.
There are typically no limitations after the injections and you can return immediately to your normal activities.
Although dermatologists often use Botulinum toxin for cosmetic purposes, only a neurologist is qualified to determine whether the injections can help with certain PD symptoms. If you are interested to investigate whether Botulinum toxin injections may help you, discuss this with your neurologist. If he/she feels that they may be helpful, but does not perform them, he/she can refer you to a neurologist who does.
Tips and takeaways