title: Botulinum toxin injection pain relief using a topical anesthetic skin refrigerant.
abstract: BACKGROUND
  This study was performed to determine if pretreatment application of a topical anesthetic skin refrigerant reduced discomfort during botulinum toxin injection.
  
  
  METHODS
  Twenty patients were assigned to four groups determined by side of the face pretreated with skin refrigerant and side receiving the first injection. On a Visual Analog Scale of 0-10 patients rated discomfort levels after injections in the glabellar complex with and without pretreatment.
  
  
  RESULTS
  Mean discomfort rating for the pretreated side was 3.1, while the mean discomfort rating for the non-pretreated side was 4.5. Discomfort was not affected by the side sprayed (p=0.33) nor by administering the injection to the sprayed side first (p=0.37). The paired t-test revealed a significant difference between discomfort levels on the pretreated and non-pretreated sides (p=0.038) yielding a 95% confidence interval of (-2.71, -0.09).
  
  
  CONCLUSIONS
  Topical anesthetic skin refrigerant significantly reduces discomfort in a cost-effective manner for reported by patients undergoing botulinum injections.
authors.affiliation: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Engel
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Afifi
authors.forename: James E
authors.initials: JE
authors.lastname: Zins
mesh_terms: D000287:Administration, Topical; D000336:Aerosols; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects*; D004338:Drug Combinations; D005157:Facial Pain / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D006845:Hydrocarbons, Fluorinated / Q000008:administration & dosage / Q000627:therapeutic use*; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D010147:Pain Measurement; D012044:Regression Analysis; D016896:Treatment Outcome; D005466:Fluorocarbons
chemical_list: D000336:Aerosols; D000779:Anesthetics, Local; D019274:Botulinum Toxins, Type A; D004338:Drug Combinations; D006845:Hydrocarbons, Fluorinated; D009465:Neuromuscular Agents; C552522:pain ease refrigerant; C541451:pentafluoropropane-tetrafluoroethane; D005466:Fluorocarbons