A few injections of Botox – carefully placed by a skilled hand – may be all it takes to relief one of life’s most painful conditions, a kind of facial pain called TN.
Trigeminal neuralgia is often simply called TN or sometimes referred to as tic doulourex. Whatever you call it, the condition involves severe facial pain that patients often describe as a sudden stabbing pain.
The original study showing the potential benefit of Botox was small and short – but the results were nothing short of amazing. Involving 13 patient with trigeminal neuralgia, the results were so promising that they justified a larger and longer trial. Researchers involved in the original study include E.J. Piovesan, MD, a Panama neurologist with the Hospital de Clinicas da Universidade Federal do Parana. The study was published in the journal Neurology.
Understanding The Original Study’s Findings
Since the initial study, more research has proven the findings to be true. In the original study, before having Botox all the patients had severe face pain linked to trigeminal neuralgia. They got a single carefully planned Botox treatment. In all 13 patients, there was an easing of pain gradually over 60 days. Just 10 days after the treatment, there was a significant drop in pain. Within 20 days, some patients were nearly symptom-free. For all, pain intensity dropped and there was a reduction in use of pain medicine.
Those are promising results indeed. And remember that the results of this small and short study have been proven again and again in other research.
Four of those original patients stopped using medication altogether. Other cuts usage of pain medication by over half.
And even better, Botox didn’t seem to interact badly with the pain medicines these patients were taking. And after 60 days, the relief continued. Other research indicates the benefits could continue for much longer.
How To Use Botox For Trigeminal Neuralgia
TN is one of the most painful conditions a human can have, according to doctors. The classic form of this condition – called TN1 – involves sporadic, sudden and extreme cases of a sudden burning or shocking in one of the branches of the fifth cranial nerve. This means the symptoms can be felt and seen in the lips, nose, eyes, scalp, forehead or either jaw. Episodes may last only a moment or last as long as 2 minutes. The pain may happen all at once or in volleys over two hours. The pain is usually described as sharp and stabbing.
In another form of the condition, TN2, pain is less intense but constant. It’s possible for a patient to have both conditions.
Dr. Katz suggests that the sites to be injected for TN treatment vary according to known trigger zone areas. These differ from one patient to the next. Injections should only be given when the motor side effects of the Botox treatments do not cause severe facial esthetic or functional distortion. These may be reduced or even prevented by injecting 0.025ml of concentrated Botox at the trigger zone.
Suggested in a groundbreaking small, short study and shown to be true in other research since, Botox can make a huge difference in the lives of TN patients. But someone has to be willing to provide the shots that provide the change.
Would you like to be involved in a Botox practice that makes a real difference in people’s lives? It’s possible when you take our Botox training course.. and step forward as an expert in treating conditions that simply can’t be successfully dealt with any other way.
One of the key things that any medical professional should know is not something that many medical schools will teach. It’s not something that you will be able to learn from a medical textbook, and it is rarely something that is discussed openly with the medical community – and that is being paid by your patient’s medical insurance. Money matters should not be something that we avoid, and we should always be open with our patients about the cost of the treatment that we are giving them, along with the many medical and cosmetic benefits that they will receive. This ensures that the process of gaining the attention of their insurance company should not be too difficult.
When you contact a medical insurance company, you will need to have a letter of medical necessity from their primary care physician. When you have a consultation with them they should be able to hand that over, and you will then be able to forward that on to their insurance company. In this letter of necessity, it needs to have their complete migraine diagnosis, and this needs to include the fact that they have had migraines of this severity for at least six months and for at least fifteen days per month. It also needs to state by their primary physician that all oral medications that they have been prescribed have been completely ineffective.
Once you have done this, the medical insurance company should allow you to proceed and give the treatment. If a patient requires ongoing treatment, then you will need to demonstrate to the insurance company that there has been at least a 50% improvement to their medical migraine condition since the first lot of treatment, in order to convince the insurance company to continue to cover the cost.
Botox is not a magic potion. It cannot fix absolutely everything, much as we would wish it, and sometimes when less experienced individuals administer Botox, it can create inadvertent side effects that the patient was definitely not hoping for! One of the most common Botox side effects that people worry about is getting the permanently surprised look – something that some celebrities get when they decide to have too much Botox. So if a patient comes to you with the ‘surprised!’ look side effect, how do you go about fixing that – and how can you yourself make sure that you never make that mistake?
The ‘surprised!’ look is often created because the patient’s eyes are now naturally far too wide and open, giving them that ‘deer in the headlights’ sort of expression. This happens because there are two main muscle groups on our foreheads: one group that pushes downwards, and one group that pulls upwards. Some Botox professionals will only give Botox injections to the muscles that push downwards, and when they relax it means that all that is happening on the patient’s forehead is pulling upwards! This creates the startled look.
If that does happen, or a patient has come to you with that side effect, it is an easy enough problem to remedy. All you need to do is give them two small injections near the top of the forehead, to relax the muscles that are continuously pulling upwards. This balances out the muscles in the forehead, and means that their forehead is able to relax, balancing out their features, allowing the eyes to naturally relax, and removing the ‘surprised!’ look that they had. As this happens with 1 in 20 patients you may find it a common problem that people ask you to fix.
If there is one thing that almost every single person becomes self conscious about in their life, at one point or another, it is their smile. For some people it is the colour of their teeth, and for others it is any gaps in their teeth that they have. For some people it is the lines around their mouth that appear when they smile, and for others it is an imbalance between the size of their nose and their mouth. For whatever reason, you as a Botox medical professional may find during your professional career that you often see people come to you and ask you to ‘fix their smile’. So what does this mean in practice?
Well, most of the time that a patient who dislikes their smile goes to a Botox professional, it is because they have a very gummy smile – and they want you to be able to change that. What your patient probably doesn’t know, although you will, is that the muscle that controls the way that our smile looks and can create a gummy smile is the same muscle that controls the nasolabial fold. This means that if your patient with a gummy smile also has a deep set nasolabial fold, you will be able to give them the good news that it will be simple for you to transform their face and smile completely with just one set of injections.
Very few patients hate their smile so much that they will attempt to medically alter it, but if this does happen then we as medical professionals are honoured to be able to transform their smiles and therefore indirectly transform their lives. Confidence is something that money can buy, and it can be achieved through well thought out and talented Botox injections.
Research seems to have proven something pretty amazing: Botox can offer dramatic relief from facial pain – even severe facial pain – when injected properly and in the right places.
In the original study on the topic, botulinum-A toxin – what we simply call Botox – was injected in 13 patients with a severe facial pain condition called trigeminal neuralgia. The injections were carefully placed directly into key positions in the face of the patients, and the result was a dramatic reduction in pain.
More About The Study
In fact, 4 of the 13 patients in that original study no longer needed any oral pain medication at all, and the remaining patients all reduced the amount or pain medicine they needed by over half. That’s especially hopeful information for sufferers of trigeminal neuralgia since drugs aren’t always very helpful for them, according to neurologists familiar with the research. Also, some patients with the condition choose to avoid pain drugs because of unpleasant side effects and the possibility of pain becoming more intense and lasting longer.
To determine how much Botox should be used for this kind of treatment, an open-label study was conducted involving 13 patients to determine the minimal dosage. All of these 13 patients met the criteria for trigeminal neuralgia established by the International Headache Society. Four patients experienced symptoms in just one branch of the nerve while others had symptoms in two or more branches.
Patients were asked to report how much of their regular medication they needed before beginning the study and then at 60 days after having the injections. All patients started with severe pain and improved.
The amount of the dosage depended on how much surface pain was reported and ranged from a low of just 6.83 units to as much as 9.11 units.
Pain was shown to gradually reduce, and the Botox injections reached a peak of effectiveness 20 days after treatment. After 60 days, 4 patients no longer needed pain medication at all. The rest had reduced medication by half or more. There were 3 patients in the study who took more than one drug before the Botox treatment, and they all reduced to one drug at a lower dosage.
The study did not involve a long enough time frame to determine how long the Botox treatments last. But later studies have proven that the results from the original study are sound and that results can be longlasting.
Understanding The Condition
Trigeminal neuralgia is just one of the many medical conditions that may benefit from Botox treatment. Others include eyelid and ocular muscle issues, blepharospasm, dystonia, strabismus and more.
Also called simply TN, trigeminal neuralgia is known to be one the most painful human medical afflictions. The disorder of the fifth cranial nerve causes extreme, sudden and sporadic burning or shock-like sensations at the nerve’s branches in the lips, nose, face, eyes, forehead, scalp and jaws. Pain can last from only a moment to as much as two minutes. Attacks may happen rapidly and frequently over a two-hour period before subsiding. Some patients have a form of the condition called TN2 which involves constant pain at a lower intensity.
Dr. Katz understands that not all trigeminal neuralgia patients are alike, and he indicates that the sites injected for trigeminal neuralgia vary according to know trigger zones that differ from one patient to the next. It’s important, he adds, that injections are only given so that there are no motor side effects and no severe distortion of facial esthetics or changes in function. Any possible unwanted impacts can be reduced or even prevented by injecting 0.025ml of concentrated Botox at the trigger zone.
Great for aesthetics and life-changing for therapeutic purposes, Botox is a wonder drug for some people. And the people who choose to offer Botox injections are often seen as miracle workers by those who can find relief no other way.
If you are a medical professional interested in learning to treat your patients with Botox, call (858) 550-9533 today.
Very few people in the world would happily pick up a yoghurt that was six months out of date, and eat it with a spoon and a large smile on their face. Why? Because we have been conditioned for years to pay attention to use by dates because we believe that they are there to protect us – and we know, because we have been told so often and from so many quarters, that using something that is past its use by date is just dangerous. It won’t be as good! Many medical professionals have the same approach to the Botox that they use.
Every medical professional who works with Botox will know that if you mix your Botox with saline, that solution will be able to be used for up to two days, which is a not long time – but it could be longer. The manufacturers of the most Botox solutions always recommend that you mix it with saline, but we would recommend that instead, you mix it with bacteria static saline. If you do that, that solution will be perfect for using for up to two weeks, a whole two days longer which will enable you to keep it for patients that you want to see after a weekend, for example. After that, the Botox is considered to be out of date, and its shelf life has come to an end.
Altering the length of time that you can use your Botox solutions means that you could really easily save a lot of money, because you will not have to throw out your Botox solutions every two days. This will dramatically change your spending habits at work, and will make Botox injections even more cost effective than they already were for you and your practice.
One of the most aging thing that happens to our faces as we get older is that our foreheads and brows seem to get heavier and larger, causing them to slip down and overwhelm our eyes as well. This look overall definitely can age a person up to a decade more than they really are, and so a quick and easy way of reducing the appearance of a person’s age is to treat this. For many patients, they will unconsciously feel more tired and run down throughout their day just because of the way that they look. It is remarkable the effect that the way we look can have on us, and so many patients with heavy brows will come to you to ask for Botox injections across their forehead.
The key way to do this is to understand that there are two main muscle groups in our foreheads; one set that are up pulling upwards towards our hair line, and another set that are pushing downwards towards our eyebrows. As we get older, the group of muscles that are pushing downwards becomes stronger and more dominant which is what creates this look. In order to reverse it, you need to inject into the muscles on the forehead and help them to relax, allowing the group of muscles that pull upwards to become stronger, and give the patient a fresher, awake, and younger appearance.
It is incredible to see a patient first look at themselves after successful Botox treatment has been carried out on them to change the way that their brow looks; sometimes they do not even believe that they are looking at their own reflection! Help your patients to get a new lease of life by offering this life changing treatment, and help lighten heavy brows.
So much of who we are is dependent on the way that other people see us, and even people who are really confident on the outside will often have one thing about them that they are very self conscious about, and would never want to draw attention to. When someone goes to you as a medical practitioner and asks for Botox, they may be doing so because there is something about their appearance that they do not like and they want to correct it – and the absolute last thing that they would wish is to have their scars made worse rather than better! Although rare, this can happen in some cases, so when it comes to giving Botox injections how can you reduce scarring?
Scarring most often occurs on the forehead, and many patients will come to surgeries because they want scars on their foreheads diminished. It is possible to do this with Botox. The key thing to know is that a horizontal scar on a forehead is still interacting with the muscles around it, and by treating the muscles around it you can diminish the look of the scar really easily. As the muscles fibers are pulling, if you inject the muscles above and below the scar, then the muscles will relax and immediately make the scar less obvious and a lot smaller.
Many people find it difficult to believe that Botox injections really can make a difference to the way that a scar looks, but they can in fact have a hugely positive effect on the way that a scar looks, making it look smaller and much thinner as well – and many patients who have become accustomed to seeing a huge scar on their forehead will find it incredible to be able to finally ignore it!
When a person decides that they want to have Botox on their face, nine times out of ten they have decided to do that because they are self conscious about the way that they are aging. This is of course a perfectly good reason to decide to have Botox, but that can often mean that those patients are even more aware of any accidental side effects that may occur, and one of those is uncontrolled drooling – definitely not something that a self conscious person wants to suffer! That is why it is critically important for you to do your utmost to make sure that you prevent the side effect of drooling. But how can you do this?
Well, first of all, this occurs when Botox is injected below the nose and around the mouth, and in most cases drooling as a side effect will only occur in patients who have experienced Bell’s Palsy in the past. They may not really be aware of it if it was a very mild case, but there is an easy way to find out: ask them to pucker their lips. Most people will be able to do this easily, but if you see any asymmetry in their pucker you will immediately know that there is some weakness there already. This means that you should avoid doing any Botox injections around the mouth, because the muscles there are just not going to be strong enough.
Knowing your patient is the most important thing that we can do in medicine, and you’ll find as you go that prevention is better than cure when it comes to creating a drooling side effect. Getting to know your patient better will immediately help you to prevent this rather embarrassing and slightly inconvenient side effect.