Duly noted and thank you.
I contacted Dr. Terlecki at Wake Forest who ran the NIH study out of Wake Forest in 2014. Botox blocks (different from the “scrotox”) helped some people but ultimately never recruited enough subjects -because few wanted to risk being in the placebo arm. I don’t know if insurance will cover much of this, but my biggest concern is could this negatively impact in some way a future SCD surgery.
Of course the home run would be that the block cools things off long enough so that surgery isn’t necessary at all.
While the mechanism for analgesia with Botox remains fuzzy at best, my guess is that the cremasteric muscle in the spermatic cord is angry and that muscle is chock full of nerve fibers. Blockade of the neuromuscular junctions within the SC may relax that muscle.