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Chapter 28 - Botulinum Toxin in the Treatment for Ischemic Digits and Chronic Pain
- Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
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- Book:
- Manual of Botulinum Toxin Therapy
- Published online:
- 02 November 2023
- Print publication:
- 23 November 2023, pp 230-236
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Summary
Raynaud’s phenomenon is a vasospastic disorder with a reported prevalence of between 3% and 5% of the general population, is nine times more common in females and typically occurs between the ages of 15–40 years. It may be primary or occur in the setting of connective tissue disorders. Exaggerated vasoconstriction of the digital arteries in response to certain environmental triggers, typically cold temperatures, leads to pale, cold, numb and sometimes painful digits. In extreme cases, digital artery vasospasm leads to diminished blood supply to the fingertips, which causes pain, disuse and exposure of the distal phalanx, and may necessitate amputation.
Injection of botulinum neurotoxin (BoNT) into the hand, typically at the base of the fingers, produces increased blood flow, oxygenation saturation, pain reduction and promotion of ulcer healing, with prolonged benefit over several months. This chapter details the use of BoNT for ischemic digits caused by Raynaud’s phenomenon, including injection technique, dosing and quantification of perfusion and oxygenation using laser Doppler.
Contributors
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- By Michael H. Allen, Leora Amira, Victoria Arango, David W. Ayer, Helene Bach, Christopher R. Bailey, Ross J. Baldessarini, Kelsey Ball, Alan L. Berman, Marian E. Betz, Emily A. Biggs, R. Warwick Blood, Kathleen T. Brady, David A. Brent, Jeffrey A. Bridge, Gregory K. Brown, Anat Brunstein Klomek, A. Jacqueline Buchanan, Michelle J. Chandley, Tim Coffey, Jessica Coker, Yeates Conwell, Scott J. Crow, Collin L. Davidson, Yogesh Dwivedi, Stacey Espaillat, Jan Fawcett, Steven J. Garlow, Robert D. Gibbons, Catherine R. Glenn, Deborah Goebert, Erica Goldstein, Tina R. Goldstein, Madelyn S. Gould, Kelly L. Green, Alison M. Greene, Philip D. Harvey, Robert M. A. Hirschfeld, Donna Holland Barnes, Andres M. Kanner, Gary J. Kennedy, Stephen H. Koslow, Benoit Labonté, Alison M. Lake, William B. Lawson, Steve Leifman, Adam Lesser, Timothy W. Lineberry, Amanda L. McMillan, Herbert Y. Meltzer, Michael Craig Miller, Michael J. Miller, James A. Naifeh, Katharine J. Nelson, Charles B. Nemeroff, Alexander Neumeister, Matthew K. Nock, Jennifer H. Olson-Madden, Gregory A. Ordway, Michael W. Otto, Ghanshyam N. Pandey, Giampaolo Perna, Jane Pirkis, Kelly Posner, Anne Rohs, Pedro Ruiz, Molly Ryan, Alan F. Schatzberg, S. Charles Schulz, M. Katherine Shear, Morton M. Silverman, April R. Smith, Marcus Sokolowski, Barbara Stanley, Zachary N. Stowe, Sarah A. Struthers, Leonardo Tondo, Gustavo Turecki, Robert J. Ursano, Kimberly Van Orden, Anne C. Ward, Danuta Wasserman, Jerzy Wasserman, Melinda K. Westlund, Tracy K. Witte, Kseniya Yershova, Alexandra Zagoloff, Sidney Zisook
- Edited by Stephen H. Koslow, University of Miami, Pedro Ruiz, University of Miami, Charles B. Nemeroff, University of Miami
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- Book:
- A Concise Guide to Understanding Suicide
- Published online:
- 05 October 2014
- Print publication:
- 18 September 2014, pp vii-x
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Chapter 23 - Botulinum neurotoxin A treatment for ischemic digits
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- By Michael W. Neumeister, Department of Plastic Surgery, Southern Illinois University School of Medicine, Carbondale, IL, USA, Kelli Webb, Department of Plastic Surgery, Southern Illinois University School of Medicine, Carbondale, IL, USA
- Edited by Daniel Truong, Dirk Dressler, Mark Hallett, Christopher Zachary
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- Book:
- Manual of Botulinum Toxin Therapy
- Published online:
- 05 February 2014
- Print publication:
- 23 January 2014, pp 203-209
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Summary
Raynaud’s phenomenon
Raynaud’s phenomenon is a vasospastic disorder that affects over 9 million people in the USA (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2006). Maurice Reynaud’s description of arterial insufficiency to the fingers in 1862 led to his name being the eponym of this condition. He described the process as a “local asphyxia of the extremities” as a result of “increased irritability of the central parts of the cord presiding over vascular innervation.” Raynaud’s phenomenon is nine times more common in females and typically occurs between the ages of 15–40 years. These patients have an exaggerated vasoconstriction of their digital arteries in response to certain environmental triggers, which leads to pale, cold, numb and sometimes painful digits. These symptoms can last minutes to hours and may reoccur several times through the day. For the majority of patients, the symptoms are simply bothersome, but for 20% the symptoms are so severe that they seek medical attention. The digital artery vasospasm leads to diminished blood supply to the fingertips, which causes pain, ulcerations and disuse. Many patients require digit amputations for recalcitrant ulcers or exposure of the distal phalanx. The resultant digit ischemia may be also associated with considerable morbidity associated with loss of function, disability and depression.
Primary Raynaud’s disease is an idiopathic condition, and secondary Raynaud’s disease is associated with other connective tissue disorders. Secondary Raynaud’s disease affects 90% of patients with scleroderma, 90% of patients with mixed connective tissue disease, 33% of patients with lupus and 33% of people with Sjögren’s syndrome. The pathophysiology of primary versus secondary Raynaud’s disease is likely different, with secondary Raynaud’s disease invariably causing more severe and debilitating symptoms (Figs. 23.1 and 23.2).