Traditional Nerve blocks vs Botox

[bti20]

I saw a pain management consultant in the UK this afternoon. We arranged that he would begin a series of four fortnightly nerve blocks on the 7th January next year. He also suggested that I take amytriptiline and neurontin conjointly for a while to see if that would have any effect on my symptoms. He is arranging for me to see a physiotherapist, and has also suggested that I apply some hydrocortisone cream to my foreskin/frenulum area. He said that I should try to play some sport at the level of intensity that I used too, i.e. football, to see if it makes me feel better (notwithstanding this site's protocol, I think I will give it a go, although I don't really feel like it). I am also planning to see an acupuncturist once before Christmas and once afterwards - and maybe more if there's time.

This pain consultant reckoned that I damaged a 'skin tag' (containing a nerve) on the underside of foreskin and thus had set off a nasty nervous system response. He thought that the muscular component of my condition was secondary to the hypersensitivity component.

I will keep the group informed as to the success of all this. If anyone has any comments I would be grateful. Especially I am a bit concerned about putting hydrocortisone cream on my genitals when you are not even supposed to put it on your face Best regards.

[webslave]

Those creams are only bad if you use them for a very long time, when they start thinning the skin. Keep us updated, it's very interesting.

[J Dimitrakov]

Nerve blocks usually make this condition worse. I don't know why pain specialists still perform them.

[webslave]

Could you briefly outline for us why this is so? I know Botox is being used experimentally for CP/CPPS, and I'd like to be educated about the way this differs from a traditional nerve block ... sorry for the ignorance, just haven't had time to brush up on neurology

[bti20]

Ditto.

[J Dimitrakov]

Could you briefly outline for us why this is so? I know Botox is being used experimentally for CP/CPPS, and I'd like to be educated about the way this differs from a traditional nerve block ... sorry for the ignorance, just haven't had time to brush up on neurology

Well, the main explanation at this time is that Botox relaxes pelvic floor muscles and hence relieves muscle-related pelvic pain. My educated guess at this time is that it does more than that. Since it blocks acetylcholine action on muscles I suspect it also interferes with the pathologic balance between acetylcholine and adrenaline and noradrenaline which can be implicated in pathologic pain states. Also, since acetylcholine is also a nerve cell mediator, it can also block pathologic pain perception and transmission by blocking acetylcholine action on nerves, too. It would be interesting to study a number of markers when evaluating the action of Botox. Traditional nerve blocks just trigger an already pre-existing neuropathic pain state by releasing pain mediators at the site of the block (e.g. NGF, CGRP).

[webslave]

I guess that the sort of block used for surgery does not affect acetylcholine, or does it? Is it merely a medium-acting local anesthetic of sorts ...?

[J Dimitrakov]

Yes, that is the sort of nerve block we are talking about.

I guess that this sort of block does not affect acetylcholine? Is it merely a medium-acting local anesthetic of sorts ...?

It's usually lidocaine. Some pain specialists use cortisone as well.

[webslave]

It's usually lidocaine.

:icon_smile_lachuh: Ha! Well, comparing Lidocaine to Botox is like comparing a pellet gun to a Cruise missile! Bti20, pity you can't get the Botox, that's the good juice.

[bti20]

I'm pretty sure I remember him talking about a 'cortisone' nerve block. He said he'd try that first, and then, if there was no benefit, he'd do an x-ray guided one, I think, into the spine. To be honest, I'm so fed up of having this pain with nothing done about it, I was glad to have someone offer a positive (?) proposal for treatment. The reason I'm game is that I'm sure its nerves that are causing my prostatitis, so surely nerve blocks are the appropriate action (as well as physiotherapy)? Very confused and fed up....

[jori]

I asked this already elsewhere but will repeate my question. What makes Botox so promising in treating urgency/frequency problems of OAB or IC compared to other nerve affecting meds ? What is the supposed mechanism with the Botox that helps with urgency and frequency?

[alprost]

He said that I should try to play some sport at the level of intensity that I used too, i.e. football, to see if it makes me feel better

--If you DO have pelvic floor muscle problems/dysfunction, I'd be VERY wary about performing an explosive activity such as football, and would suggest a more gradual exposure to increasing intensities of exercise to see if it helps or hurts (probably after seeing a physiotherapist).

--Also, I would make sure that the physio you get reffered to has an in depth understanding of pelvic floor dysfunction. I have seen two who did not, and almost wrote physiotherapy off because of it. I had to call several physios before I found one who had a clearly outstanding knowledge, and am starting to progress after only 2 weeks of treatment.

[bti20]

Thanks for the warning alprost. Unfortunately I already went for two jogs. One last night gave me a flare-up before I went to bed, but I woke up feeling OK this morning so I went for another light jog. However, now I feel pretty bad - crampy, spikey painful feeling in my pelvis and a strange hovering pain on my right testicle which I never had before (the pain, not the testicle!). So yes, you're right, the exercise is NOT a good idea. I hope no permanant damage has been done.

How will I know if the physiotherapist is suitably qualified? Must they have expertise in treating pelvic muscle problems? And are you really getting improvement after two weeks?

Bset Regards.

[webslave]

What makes Botox so promising in treating urgency/frequency problems of OAB or IC compared to other nerve affecting meds ? What is the supposed mechanism with the Botox that helps with urgency and frequency?

This has already been answered by Dr Dimitrakov. Botox is

• long-lasting
• uniquely affects acetylcholine
• acts differently to traditional nerve blocks
• may allow the nervous system to press its "reset" button in the affected area.

[alprost]

Unfortunately I already went for two jogs. One last night gave me a flare-up before I went to bed, but I woke up feeling OK this morning so I went for another light jog. However, now I feel pretty bad - crampy, spikey painful feeling in my pelvis

Yep, been there!

Please bear in mind I'm only a patient, and can only base my comments on my own experiences. The fact that exercise has such an effect might suggest a mechanical/physical component. A good physio will probably be able to do one of two things in this regard: (i) Rule out any pelvic floor dysfunction; or (ii) confirm a pelvic floor dysfunction and devise a treatment strategy which will hopefully help your symptoms. I would definately reccomend seeing a physio to see if there is anything they can do for you.

How will I know if the physiotherapist is suitably qualified? Must they have expertise in treating pelvic muscle problems?

That is a difficult one, and I'm certainly no expert. I read up on PFD and as soon as I spoke to this physio I just knew that he really knew his stuff. During my initial appointment he took a lot of time to ask me quesions relating to my symptoms (something my Uro never really did!), and explained his diagnosis in a detailed but understandable way. I would read the following links, and discuss your condition with a physio, if they are well informed it will probably be quite apparent to you.
http://www.pelvicdysfunction.ca/cpp.htm
http://www.incontinet.com/prostatitis.htm
https://ucpps.men
https://ucpps.men/the-wise-anderson-protocol
http://prostatitis--dot--org/tensiondisorder.html
http://prostatitis--dot--org/myofascial.html

And are you really getting improvement after two weeks?

Yes - Coccyx pain, perineal pain; anal pain, pubic pain all approx. 30% better; significant functional improvements in physios diagnostic tests.

Urinary frequency & urgency 40-50% better.

Whether this improvement continues remains to be seen, but for the first time I do have a degree of optimism. The trigger point treatments are bloody painful though, and the rehab exercises require dedication to stick to! Nothing that any chronic prostatitis / chronic pelvic pain syndrome sufferer wouldn't put up with though.

Good luck,
Al.