title: Pain sensation during intradermal injections of three different botulinum toxin preparations in different doses and dilutions.
abstract: BACKGROUND
  Pain sensation associated with injections of botulinum neurotoxin (BoNT) is commonly reported. To date differences in pain sensation between the commercially available products containing BoNT have not been quantified.
  
  
  OBJECTIVE
  The pain sensations during injection of Dysport, Botox, Neurobloc, and pure saline (control) were compared. In addition, the nociceptive effect of different volumes used for the dilution of the same BoNT dose was investigated.
  
  
  METHODS
  In a prospective, double-blind, controlled trial, 10 healthy subjects were injected intradermally with Dysport (12 U), Botox (3 and 4 U), Neurobloc (150 and 300 U) reconstituted in 0.9% saline, and pure saline. Pain sensation was quantified during injections.
  
  
  RESULTS
  Neurobloc injections caused significantly more injection pain than Botox, Dysport, and saline. No significant differences between Dysport, Botox, and saline were found, although there was a trend toward less pain with pure saline injections. Higher pain levels with higher volumes could not be demonstrated significantly.
  
  
  CONCLUSIONS
  Our data demonstrate that BoNT type B injections are associated with substantial pain. There is a considerable difference between the commercially available BoNT type B compared to the two BoNT type A preparations. Therefore, considering mitigation of injection pain seems necessary when using BoNT type B.
authors.affiliation: Department of Neurology, Division of Neurorehabilitation, Medical University of Vienna, Vienna, Austria. gottfried.kranz@meduniwien.ac.at
authors.forename: Gottfried
authors.initials: G
authors.lastname: Kranz
authors.forename: Thomas
authors.initials: T
authors.lastname: Sycha
authors.forename: Bernhard
authors.initials: B
authors.lastname: Voller
authors.forename: Andreas
authors.initials: A
authors.lastname: Gleiss
authors.forename: Peter
authors.initials: P
authors.lastname: Schnider
authors.forename: Eduard
authors.initials: E
authors.lastname: Auff
mesh_terms: D000005:Abdomen; D000293:Adolescent; D000328:Adult; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000009:adverse effects; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D011446:Prospective Studies; D015595:Skin Aging / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; C096323:rimabotulinumtoxinB; D001905:Botulinum Toxins; D019274:Botulinum Toxins, Type A