Type A botulinum toxin in the treatment of chronic facial pain associated with masticatory hyperactivity.
OBJECTIVE
Chronic hyperactivity of the masticatory muscles is a common functional disorder associated with chronic facial pain and headache. The positive therapeutic effect of botulinum toxin type A on functional disorders and pain symptoms has been known in connection with the treatment of cervical dystonia. The purpose of this report is to assess whether the targeted reduction of masticatory muscular hyperactivity by local injection treatment with botulinum toxin type A can improve facial pain headache symptoms in the event that other treatment methods prove ineffective.


METHODS
In an randomized blinded placebo-controlled study, 90 patients (60 verum and 30 placebo) with chronic facial pain were treated with botulinum toxin type A (Botox; Allergan, Ettlingen, Germany) injections into masticatory muscles.


RESULTS
Ninety-one percent of patients who received botulinum toxin improved by a significant mean reduction of approximately 3.2 on a visual analog pain scale. By comparison with t test and chi(2) test, there was a significant difference compared with the placebo group (P <.01).


CONCLUSIONS
The local injection of botulinum toxin type A constitutes an innovative and adequately efficient treatment method for chronic facial pain associated with hyperactivity of the masticatory muscles. An improvement in the painful symptoms can be expected in up to 90% of patients who do not respond to conservative treatment methods.
von Lindern
Jens J
JJ
Department of Maxillofacial Surgery, University of Bonn, Bonn, Germany. vonlindern@mkgchirug.de
Niederhagen
Bernd
B
Bergé
Stefaan
S
Appel
Thorsten
T
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005157:Facial Pain / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008410:Masticatory Muscles / Q000503:physiopathology*; D009119:Muscle Contraction / Q000502:physiology; D009135:Muscular Diseases / Q000628:therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010147:Pain Measurement; D010919:Placebos; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D016037:Single-Blind Method; D013704:Temporomandibular Joint / Q000503:physiopathology
D009465:Neuromuscular Agents; D010919:Placebos; D019274:Botulinum Toxins, Type A