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Current treatment of Raynaud phenomenon includes avoidance of precipitating factors and the use of antiplatelet agents, calcium-channel blockers, nitrates, ACE inhibitors, anticoagulation, and intra-arterial injection of reserpine. The clinical response to such strategies has been variable. Digital artery sympathectomy can relieve symptoms, but recurrence is frequent. In this case series, 11 patients with very painful symptoms of Raynaud phenomenon underwent perivascular digital and palmar Botox injections in one hand. Pretreatment pain was associated with digital ulcerations, and the patients had been unsuccessfully treated with vasodilators, antiplatelet agents, narcotic analgesics, and intravenous prostacyclin. They received a total of 1…