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  • Trigger Point Injections (Not Botox)

    Hi everyone. I posted this a few weeks ago in the pelvic floor therapy forum but got no replies so I'm wondering if maybe someone here could help me. My gynecologist really wants me to try trigger point injections for my pelvic floor. I've seen Dr. Hibner here in Phoenix and we've discussed Botox but for various reasons, I've decided that's not in my best interest. I am making some progress with PT for the dysfunction in my pelvic floor but even with seeing the therapist weekly and doing daily stretches and exercises, I still have very tender trigger points, both internally as well as externally. These cause pain when worked on but mostly I just experience frequency and urgency all day, every day.

    For this, they'd put me under anesthesia and then give me multiple injections into the pelvic floor (NOT the bladder) with lidocaine and some sort of cortisol/cortisone/steroid to help relax the muscles and reduce inflammation. I was very adamant that I didn't want to worry about any of the side effects like retention or incontinence that can happen with Botox and my gyno assured me that that would not be the case with this. I asked him how many times I'd have to do it and he said, "As many times as you need it." Apparently with some patients, they come every few months but he said he's seen many that only need it done once and that's enough to get that pelvic floor to calm down.

    I did a search on the board for trigger point injections but most of them were either really old or only about Botox (makes sense in a Botox subforum but I don't know where else to post this question where people might be able to answer). Wondering if anyone has had anything like this done lately and if so, what your experience was with it, positive or negative. It doesn't sound like there's too much downside to trying it, at least for me. My insurance will cover it and sounds like the side effects are pretty minimal. My biggest fear is that it will make me worse and I don't know how long a steroid would stay in my system. With Botox, I know it can take months to wear off. Anyone have any info to share on this topic?
    Diagnosed with IC in April 2011. Medications and IC treatments did not help, diagnosed with PFD in September of 2013. Still searching for answers as to why I have never-ending frequency/urgency issues.

    Current medications/treatments:
    Pelvic physical therapy, valium suppositories, b and o suppositories, acupuncture, probiotics, magnesium, epsom salt baths

    Previous medications/treatments:
    Elmiron, Hydroxizine, Elavil, VESIcare, Series of rescue instillations using Elmiron, water, lidocaine, & sodium bicarb and self-cathing with instills as needed, D-mannose, Glucosamine, Hyophen (generic Prosed), Colostrum, IC diet, PTNS, chiropractic treatments, Desert Harvest Aloe Vera, CystoProtek

  • #2
    Re: Trigger Point Injections (Not Botox)

    You don't go into detail so let me ask you something. Do you continue at home with trigger point therapy with the TheraWand? When I was first evaluated and diagnosed with PFD, I received internal trigger point release therapy with the PT but she also instructed me on how to perform this at home, as well. Without that, you won't improve. My trigger points are always sore and my pelvic muscles tight. But besides certain exercises, the TheraWand has been a key treatment. Exercises alone won't do it.

    If internal trigger point release therapy at home isn't part of your program, I would speak to your therapist right away before going ahead with injections.

    Good luck.
    **************************************************************

    Experienced first symptoms in 2007
    Diagnosed with IC 6/13

    Diagnosed with PFD (Pelvic Floor Dysfunction) 8/13

    Medications: .5 mg. Ativan, occasionally for spasms

    Supplements: DH Aloe Vera capsules, 3 per day for maintenance and 6-12 per day during flares


    Following Strict IC Diet

    Comment


    • #3
      Re: Trigger Point Injections (Not Botox)

      I do not have the TheraWand yet but my therapist suggested I could try it. I work on the internal trigger points that I can reach by myself and then ones that I have trouble getting to, I have my husband help me with. I see my PT once a week now. Used to be twice a week. I've seen her for 21 months so far. At the beginning, everwhere she touched was painful. She said it's like peeling the layers of an onion; we're slowly (and mean apparently VERY slowly) working our way to the deeper muscles.

      If you don't mind me asking, how to you work the trigger points with the wand? Do you just insert it and let the pressure help release them, or do you have to "twirl" it or anything? My PT didn't really explain it much because i haven't purchased it. She said that sometimes people with very tender muscles can actually make things worse if they use too much pressure. I've found that to be true for me and with the ones we're working on now being so far back, I have been kind of afraid to mess around too much "up there" without her guidance.

      How long did it take you using the TheraWand to find that it was helping you?
      Diagnosed with IC in April 2011. Medications and IC treatments did not help, diagnosed with PFD in September of 2013. Still searching for answers as to why I have never-ending frequency/urgency issues.

      Current medications/treatments:
      Pelvic physical therapy, valium suppositories, b and o suppositories, acupuncture, probiotics, magnesium, epsom salt baths

      Previous medications/treatments:
      Elmiron, Hydroxizine, Elavil, VESIcare, Series of rescue instillations using Elmiron, water, lidocaine, & sodium bicarb and self-cathing with instills as needed, D-mannose, Glucosamine, Hyophen (generic Prosed), Colostrum, IC diet, PTNS, chiropractic treatments, Desert Harvest Aloe Vera, CystoProtek

      Comment


      • #4
        Re: Trigger Point Injections (Not Botox)

        No, you don't have to twirl it. Picture a clock. Depending on where your trigger points are, you move the wand to different angles, i.e. 12:00-3:00-6:00. As far as doing this at home making things worse...I can't speak to that because I've done nothing but improve. I started treating my PFD almost 2 years ago and I still do in-home therapy. When I have an IC flare, sometimes it's a PFD issue (I've learned to tell the difference). Anyway, the TheraWand helps to release a trigger point that is giving me trouble. My insurance company would never have approved 20 months worth of therapy sessions. The goal was to evaluate, diagnose, treat and educate so that I could continue at home. I check in every 6 months or so.

        I would have a serious discussion with your therapist about this. She can teach you what to do and help you during your sessions to make sure you are doing this correctly. It's really very easy. It might be worth a try before you commit to the injections.

        I hope you can get some relief soon!!

        **************************************************************

        Experienced first symptoms in 2007
        Diagnosed with IC 6/13

        Diagnosed with PFD (Pelvic Floor Dysfunction) 8/13

        Medications: .5 mg. Ativan, occasionally for spasms

        Supplements: DH Aloe Vera capsules, 3 per day for maintenance and 6-12 per day during flares


        Following Strict IC Diet

        Comment


        • #5
          Re: Trigger Point Injections (Not Botox)

          One advantage to the injections could very well be how quickly it works for you. Even though they aren't a permanent thing, once you get those muscles to relax, it should make it easier to keep them relaxed, at least for a time. Your doctor should be able to tell you how long the medication will remain in your system. The only time I had steroid injections it was for a shoulder problem and they lasted several weeks even though the problem was spurs, which had to be removed surgically.

          Donna
          Stay safe


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          Comment


          • #6
            Re: Trigger Point Injections (Not Botox)

            LoriSue, thank you for the information. My insurance didn't cover most of my therapy. They allow 18 visits, I think, and everything else I had to pay out of pocket. It is very expensive and I'm finally tapering off now but at the beginning, I couldn't even leave my house because of having to pee literally every 10 minutes and the only thing that has made my pain go down at all is the PT. I was scared to stop going. She has helped me a lot and worked on spots that there is no way I could have got to by myself. We've also discovered so many other areas that are irritated on me due to my pelvis being misaligned and adductors and hip flexors that used to be so tender, they could barely be touched without me crying in pain. I know I've been going for a long time but I just want to get well -- or even to the point where I may still have discomfort, but not the point of it having it consume my every thought -- and this is the only thing that seems to help even at all. I just feel like I'm stuck at a certain level now. I see improvement and then sometimes I really backslide for a while and I think that's because even though we can get the pelvic floor to relax, I have these other trigger points that refer pain and tightness. It's like a cycle and needs to be broken somehow. That's why I am considering the injections. My gyno makes referrals to PT's and they work together for the treatments they think best fit their patients. In my case, as Donna mentioned, it could work quickly for me and be just enough to calm things down after so long working at it.

            And LoriSue, I also want to thank you for letting me know that you've been working at this for a long time as well. I'm sorry you're still having issues but for what it's worth, your response is really comforting for me because sometimes I feel like I'm a hopeless case or something. It's great that some people find relief so quickly and I'm happy that happens but at the same time, when I read in Amy Stein's books or see Isa Hererra say that so many are "cured" after only a few months, I think, "Well, then what the hell is wrong with ME that I've been doing this going on 2 years and still have issues?" My PT said that she's had some patients only require a couple of treatments and some others need much longer to get better. I guess I fall into that latter group. Part of the reason I saw her for so long is because from the beginning, she said she estimated it would take me around 8 -12 months to really see dramatic improvement. When I started, I just put that in my head and figured I would do anything and everything i could to meet that goal and if that meant seeing her regularly for that help, I would do it. Once the one year mark came and went, maybe I just didn't want to give up. I think there were/are a lot of reasons I haven't stopped. I think I am also afraid that if I do, I feel like I am accepting that I won't ever get better. Maybe that's not the case, but that's how I feel sometimes. So to hear that you have seen improvement and that it has also taken you a long time to get to this point is encouraging to hear. Thank you and I hope things only continue to get better for you.
            Last edited by phoenixgirl; 05-29-2015, 06:23 PM.
            Diagnosed with IC in April 2011. Medications and IC treatments did not help, diagnosed with PFD in September of 2013. Still searching for answers as to why I have never-ending frequency/urgency issues.

            Current medications/treatments:
            Pelvic physical therapy, valium suppositories, b and o suppositories, acupuncture, probiotics, magnesium, epsom salt baths

            Previous medications/treatments:
            Elmiron, Hydroxizine, Elavil, VESIcare, Series of rescue instillations using Elmiron, water, lidocaine, & sodium bicarb and self-cathing with instills as needed, D-mannose, Glucosamine, Hyophen (generic Prosed), Colostrum, IC diet, PTNS, chiropractic treatments, Desert Harvest Aloe Vera, CystoProtek

            Comment


            • #7
              Re: Trigger Point Injections (Not Botox)

              Originally posted by ICNDonna View Post
              One advantage to the injections could very well be how quickly it works for you. Even though they aren't a permanent thing, once you get those muscles to relax, it should make it easier to keep them relaxed, at least for a time. Your doctor should be able to tell you how long the medication will remain in your system. The only time I had steroid injections it was for a shoulder problem and they lasted several weeks even though the problem was spurs, which had to be removed surgically.

              Donna
              Thanks, Donna. That is sort of my thinking, too. Just calm things down and maybe allow us to get to the points that just won't release no matter what else we try. Even if this was something I had to do every few months for a while but it gives me some relief, I am willing to do it. It's not like Botox where if there's retention or other issues, I'd have to wait months for it to wear off. I would obviously not want to do longterm use of steroids, even in intervals but the idea that this COULD be a missing piece for me in terms of helping my treatment makes me want to explore it. I am SO frightened of getting my hopes up though because that's proven to be disastrous for me in the past. I've tried so many things and if they don't work, it's devastating. That said, the only way I'll know, I guess, is if I try is. I very much appreciate your input. Thank you and I just read in another post that you're feeling better after all the cancer stuff. Very happy to hear that. You've certainly been though a lot and yet you are always here to offer continued support to the rest of us. Thank you.
              Diagnosed with IC in April 2011. Medications and IC treatments did not help, diagnosed with PFD in September of 2013. Still searching for answers as to why I have never-ending frequency/urgency issues.

              Current medications/treatments:
              Pelvic physical therapy, valium suppositories, b and o suppositories, acupuncture, probiotics, magnesium, epsom salt baths

              Previous medications/treatments:
              Elmiron, Hydroxizine, Elavil, VESIcare, Series of rescue instillations using Elmiron, water, lidocaine, & sodium bicarb and self-cathing with instills as needed, D-mannose, Glucosamine, Hyophen (generic Prosed), Colostrum, IC diet, PTNS, chiropractic treatments, Desert Harvest Aloe Vera, CystoProtek

              Comment


              • #8
                Re: Trigger Point Injections (Not Botox)

                Phoenixgirl - I was looking at your signature and reading what you've done thus far in terms of treatment for your IC. You don't mention diet at all. Are you following the IC diet and if so, how strictly? Diet is considered the #1 line of defense, as I'm sure you know. Just curious because even though I followed (and still do) a strict IC diet, there were a couple of foods I was eating in the beginning, thinking they were safe but it turned out they weren't safe for my bladder. Once I cut them out I was better.
                **************************************************************

                Experienced first symptoms in 2007
                Diagnosed with IC 6/13

                Diagnosed with PFD (Pelvic Floor Dysfunction) 8/13

                Medications: .5 mg. Ativan, occasionally for spasms

                Supplements: DH Aloe Vera capsules, 3 per day for maintenance and 6-12 per day during flares


                Following Strict IC Diet

                Comment


                • #9
                  Re: Trigger Point Injections (Not Botox)

                  I've tried it. It's in the "Previous medications/treatments" line. I have so many things listed, I think you just missed it.

                  I was on the IC diet for 2 years. VERY strict. It did not seem to make one bit of difference for me, although I still don't drink any coffee, orange juice, do any kind of tomato sauce or vinegar (other than white wine occasionally) due to the fact that I think those things are irritants anyway and probably just aggravate already irritated nerves from the tight muscles. I also don't eat anything that has soy if I can help it. I underwent food allergy testing recently and had a few sensitivities that we think may trigger my migraines but no real allergies. For the past 2 months, I have been eating mostly protein and vegetables. No carbs, hardly any dairy other than a bit of cheese in an omelete on the weekends, no wheat and ZERO sugar. Hasn't made a difference in my symptoms. I think the stretching and Isa Hererra's pilates/core exercises are what's helping the most right now but that's not saying a whole lot.
                  Diagnosed with IC in April 2011. Medications and IC treatments did not help, diagnosed with PFD in September of 2013. Still searching for answers as to why I have never-ending frequency/urgency issues.

                  Current medications/treatments:
                  Pelvic physical therapy, valium suppositories, b and o suppositories, acupuncture, probiotics, magnesium, epsom salt baths

                  Previous medications/treatments:
                  Elmiron, Hydroxizine, Elavil, VESIcare, Series of rescue instillations using Elmiron, water, lidocaine, & sodium bicarb and self-cathing with instills as needed, D-mannose, Glucosamine, Hyophen (generic Prosed), Colostrum, IC diet, PTNS, chiropractic treatments, Desert Harvest Aloe Vera, CystoProtek

                  Comment


                  • #10
                    Re: Trigger Point Injections (Not Botox)

                    Hi

                    I am in Phx too and continue to struggle to find relief. I was dx IC about 5 years ago and originally installations and a hydrodistention with IC diet worked well but last 2+ years have had increasingly severe pain, frequency and another round of installations which did not work, and 2 bladder hydrodistentions - Nov 2014 which provided relief for about 3 months and on 6/4/15 and I'm already having pain again!! I see Dr. Neimczyk who is a Urologist. I'm on Elmiron and have been for 2-3 years and have tried a number of other meds without success and he is talking about doing a botox injection and states he has not had any patients with adverse effects from this treatment. I have not seen a PT for pelvic floor tx but have been doing some exercises on my own yet not sure if it's working.

                    My questions are, is Dr. Hibner a Urologist? Did you discontinue the Elmiron? I'm not sure it's working for me but am afraid to stop it as it might make things worse. I have not tried the Therwand, is it more for PFD? Does insurance cover the purchase?

                    Thanks everyone!

                    Comment


                    • #11
                      Re: Trigger Point Injections (Not Botox)

                      Hi Janet,

                      Dr. Hibner is technically, I think, a gynecologist, but he's widely known as one of the best pelvic pain specialists in the country. His specialty is surgery for pudendal nerve entrapment but he also does a lot of Botox and other kinds of pelvic surgeries related to chronic pain. I just met with him again last week and he might be changing my mind on the botox. He said he does not ever inject into the bladder so the risk of retention or incontinence is extremely low. He only treats the pelvic floor with the botox and he says that it works very well for many women. That said, insurance will usually cover the surgery but NOT the botox itself, which apparently runs about $3000 per treatment. If there is still pain or frequency after the botox wears off, you need to repeat every 3-6 months. Very expensive but as my husband pointed out tonight, not really more than what I spend on acupuncture and PT now.

                      Dr. Hibner stressed the importance of continuing physical therapy after botox because it allows the therapist to work deeper into the muscles that might have been too tight otherwise. If you ever want the name of a fantastic PT in N. Phoenix, please send me a message. I love mine and she is so kind and knowledgeable. I've been seeing her for a little over a year and a half. The only drawback is that she does not take insurance. I submit my claims myself and they go towards my out of network deductible but that's about it. Funny you mention the Thera Wand. I just ordered one tonight. I'm not sure about other insurance but mine does not cover its purchase.

                      I did discontinue the Elmiron. I was on it for 2 1/2 years but do not feel it worked for me. I stuck it out because I wanted to make sure I gave it a fair shot. It does seem to take a long time to work for some. A friend of mine didn't have it kick in until a year and then it really did. Unfortunately, that was not the case for me, but like you, I was afraid to stop it, too. At one point, I was on 900mg/day. 3 times the normal dosage. My urologist at the time thought a higher dose might be needed. I gradually reduced the dosage over the course of a couple of months and when I didn't get any worse I just stopped taking it completely. Dr. Hibner says that in his experience he only feels about 30% of women are helped by it. My urologist says maybe closer to 50%. So it's worth a try because if it works, it really does work. How long have you been taking it?
                      Diagnosed with IC in April 2011. Medications and IC treatments did not help, diagnosed with PFD in September of 2013. Still searching for answers as to why I have never-ending frequency/urgency issues.

                      Current medications/treatments:
                      Pelvic physical therapy, valium suppositories, b and o suppositories, acupuncture, probiotics, magnesium, epsom salt baths

                      Previous medications/treatments:
                      Elmiron, Hydroxizine, Elavil, VESIcare, Series of rescue instillations using Elmiron, water, lidocaine, & sodium bicarb and self-cathing with instills as needed, D-mannose, Glucosamine, Hyophen (generic Prosed), Colostrum, IC diet, PTNS, chiropractic treatments, Desert Harvest Aloe Vera, CystoProtek

                      Comment

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