How much Botox costs and whether insurance pays

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If you're currently considering Botox therapy, keep in mind that this form of therapy is generally not a low-cost option, and if you have a shortage of dollars, you may not even be able to afford it. In general, Botox is more like the upscale, probably-not-covered-by-your-health-insurance form of treatment. Always check first by simply calling and asking your insurance company if Botox treatments are covered. If and when the FDA approves Botox as a therapy for chronic pain, more health-insurance providers will likely cover such treatments.

Most patients need to receive at least two vials of Botox to gain a sufficient amount of the substance to obtain relief from their chronic pain, and one vial costs about $600. As a result, in considering all the costs involved, a Botox procedure can cost at least $1,200 — and the price can go much higher than that.

However, proponents say that when Botox injections work to resolve symptoms, patients won't need lots of doctor visits, and they can also avoid taking many doses of pain medications and, thus, avoid enduring their side effects. Looking at it from that point of view, Botox injections may be cost-effective treatments for some fibromyalgia patients.

Taking On Tai Chi

The gentle art of the basic Chinese exercise movements of tai chi are usually not overly difficult to master, and generally these movements can also be a very good form of exercise for people who have fibromyalgia or other chronic-pain problems. According to the CDC, about 5 million adults in the United States have tried tai chi and 2.6 million have used it in the past year.

The basic exercises of tai chi are meant to resemble natural animal movements, such as movements that may be made by a crane, a tiger, a snake, or other animals. For example, one simple tai chi movement involves standing on one leg as a crane would.

Tai chi helps patients with FMS in two basic ways: The exercises are relatively easy to perform for people with muscle problems who find it difficult to perform more arduous exercises. Also, the exercises can help with relaxation, in a meditative sort of way.

Nerving yourself for neurotherapies in the future

A number of new treatment techniques are emerging that change the way the brain responds to pain without medications. They are called neurotherapies, and research is showing them as promising. The idea behind neurotherapies is that abnormal brain activity is one of the fundamental issues behind pain and sleep problems in FMS. Theoretically, if that abnormal function can be corrected, symptom improvement should follow.

For example, neurofeedback is a treatment option that enables users to consciously modify their electroencephalographic (EEG) brainwave patterns. Research has shown that patients with fibromyalgia have abnormal brainwave patterns, and the more severe their pain, the more abnormal the EEG pattern problem. The idea is that, when abnormal patterns are identified, subjects can use neurofeedback to modify them in a positive way, leading to improvements in their fibromyalgia symptoms.

Neurofeedback, a technique pioneered by NASA, is different from biofeedback (described in Chapter 13). With biofeedback, users concentrate on lowering their blood pressure, pulse, and body temperature to achieve a relaxed state. In contrast, with neurofeedback, users try to change their actual brain waves, with expert assistance.

Physicians and other experts who support neurofeedback as a treatment for fibromyalgia and other chronic pain problems say it can be highly effective. The International Society for Neurofeedback & Research

(www.isnr.org) is an organization promoting education and research for neurofeedback. A section of its Web site is dedicated to information for patients and families.

Neuromodulation is another high-tech treatment option for FMS patients, and one that does not rely upon feedback, as do neurofeedback and biofeedback. Instead, tiny electrical signals non-invasively target and correct abnormal brain activity. During neuromodulation therapy in a doctor's office, the patient rests in a comfortable chair. A few sensors are placed on the scalp near areas of the brain that are functioning abnormally. The sensors rest on the scalp and nothing pierces the skin, so there is no pain or discomfort. When the sensors are in place, patients close their eyes and relax. A trained clinician uses special neuromodulation equipment to monitor the patient's EEG and deliver the targeted neuromodulation signal. The process lasts about 15 minutes. Usually a few weeks of therapy with visits twice a week are needed.

Tai chi movements are also considered low-impact exercises, so they generally involve very little risk for the person who's practicing them. In fact, tai chi exercises are even recommended for elderly and sick people who are living in nursing homes — so how hard can they be for the rest of us? You may also find that regular practicing of the basic tai chi exercises may considerably ease your pain and fatigue.

How do you master tai chi? You can often take classes on tai chi movements at a community center or at your fitness club; check your local newspapers for mentions of classes. You may also want to supplement your knowledge with T'ai Chi For Dummies, by Therese Iknoian (Wiley), a helpful book that can show you all the ropes.

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