Evaluating the effects of ice application on patient comfort before and after botulinum toxin type A injections.
OBJECTIVE
To evaluate the efficacy of ice application in reducing pain during botulinum toxin type A injections.


METHODS
Prospective, randomized, single-blind clinical study.


METHODS
Sixty patients who underwent botulinum toxin A treatment on their faces were included in the present study, divided into three groups, group 1 had ice applied 5 minutes before the injection, group 2 ice was applied 5 minutes after the injection, and group 3 served as a control, receiving an injection without ice application. A numeric pain distress scale was used to assess pain intensity. Any complications arising from the injections were also recorded.


RESULTS
Sixty patients were studied between July 2007 and March 2008. The ages ranged from 32 to 76 years (mean, 58.15 +/- 10.51 years) and 49 (81.7%) were female. Forty-five (75.0%) had hemifacial spasm and fifteen (25.0%) had blepharospasm. The numeric pain distress scale was completed immediately after the injections and the results were 3.55 +/- 1.85, 5.15 +/- 2.81 and 6.1 +/- 2.63 in groups 1, 2, and 3 respectively. The ratings indicated that pain was significantly reduced in group 1 compared to group 3 (p = 0.005), but there was not a significant difference between groups 1 and 2 (p = 0.109) or between groups 2 and 3 (p = 0.448). There was a significant difference in the rate of bleeding after the injections between groups 1 and 2 (p = 0.0472), but no significant difference between groups 1 and 3 (p = 0.106) and groups 2 and 3 (p=1).


CONCLUSIONS
Using an ice application 5 minutes before or after injection showed no difference but both significantly reduce pain compared to without ice application, while 5-minute application before injection had significantly decreased the bleeding compared to both 5 minutes after injection and without ice application. The ice application is helpful in pain relief whereas the before-injection has lesser bleeding than after-injection modality.
Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Patcharin
P
Saeliw
Passorn
P
Preechawai
Nipat
N
Aui-aree
D000328:Adult; D000368:Aged; D001764:Blepharospasm / Q000188:drug therapy*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005157:Facial Pain / Q000517:prevention & control; D005260:Female; D019569:Hemifacial Spasm / Q000188:drug therapy*; D006801:Humans; D007053:Ice; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010147:Pain Measurement; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
D007053:Ice; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A