Botox Article Dr. Hibner Nov 2010

[PN-SufferVT]

Check it out...

http://www.internalmedicinenews.com/ind ... da03e20e36

[mikette]

sorry but the link doesn't work....or maybe is only a problem on my pc?
I'm curious to read, I'm very interested.

[Emily B]

Sorry, didn't work for me either.

Emily B.

[Celeste]

http://tinyurl.com/2u95yfv

Really poor results for PN patients compared to other maladies.

[merrie]

I dont think I would call 40% of PN patients seeing some improvement "really poor results." Especially if someone in that 40% avoided having an un-necessary surgery becuase they benefitted from botox and ended up not being entrapped.

Merrie

[mikette]

I think this passage below is significant, because if neuralgia is due to muscle spasm and not to the nerve, botox could work and can help the diagnosis. Am I right?

"Botox helps with muscle spasm, so by injecting Botox, one may differentiate between pain which is due to muscle spasm, and pain which is due to nerve injury," he said.

[PN-SufferVT]

I would agree that 40% is statistically significant in this case..... therefore I would again (as usual) disagree with Celeste. I haven't calculated an actual p score, but I imagine that it would prove within a 90 or 95% confidence interval to be relevant. I agree also that it seems that it is suggested or can be concurred from the article that Botox would have diagnostic properties. This is something someone with a current doctor patient relationship with Hibner could ask via email.....

PS sorry that my first link did not work.

[nyt]

Thanks for posting this very interesting article. Just a few of my thoughts.

1. There were a total of 75 patients which were a combination of 3 groups: pudendal, IC and endometriosis. I am curious of the exact breakdown of these numbers ie were there 10 pudendal patients or 50 as the greater number of patients the greater the validity of the results.
2. If I understand the procedure correctly the patients were given bilateral pudendal blocks first followed by the botox injections. How do you know that the pudendal blocks were what resulted in the improvement in VAS scores and not the botox? It would be interesting to see the study broken down into pudendal blocks only, botox only and pudendal blocks plus botox group.
3. There were patients in the group that had botox performed more than once because there were 97 procedures. What was the criteria for re-injection? It is suggested that subsequent injections results in a better VAS score? Is that better improvement with subsequent injections dependent on the initial diagnosis ie an IC patient would do better than a pudendal patient with repeat injections or do pudendal patients do better with repeat injections?
4. Looking at the numbers of patients treated with and without PT following injections is probably not statistically significant 69% versus 65% improvement suggesting to me that PT is a waste a money following botox injections. I would love to have seen a group with PT only for a comparison as this is something we are all wondering about. Also, PT did no extend the time between injections.
5. Is there an optimal "window" for reinjections? Does it need to be done before the patient notices an increase in pain when one might assume the trigger point is reactivated?
6. He reports a 3% complication rate of urinary retention that resolves after 5-7 days. I wish the complication rate was even lower. I wonder if any of the patients ended up with incontinence. He did not report the other complications as seen by Dr. Skorenki, see end of article. Is that due to the bupivacaine, technique, location of injection, or number of sites injected?
7. For patients with IC the results are encouraging but mixed. More than 1/2 saw improvement. I feel the sorriest for the 9% that got worse. I know very little about IC but it seems that finding the subset of patients that would benefit the most from this procedure is the key.
8. The botox plus bupivacaine by Dr. Skorenki is interesting but I found the presentation of the data numbers confusing. However, it might be a new treatment option that will extend the life of botox and the bupivacaine. Will be interesting of Dr. Hibner starts adding the bupivacaine to his botox injections.

Any comments about my thoughts are more than welcome.

[PN-SufferVT]

NYT,

Great analysis! Thanks for sharing..... I completely agree that it would be nice to see a more clinical/scientific based study of the treatments independently.