title: Botulinum injection for the management of myofascial pain in the masticatory muscles. A prospective outcome study.
abstract: We prospectively analysed the outcome after botulinum injection in patients who did not recover after conservative measures to manage masticatory myofascial pain, and who were not willing to take low dose tricyclic antidepressants as a muscle relaxant. We prospectively 62 patients were assessed with visual analogue scores (VAS) for pain on the affected side before, and 6 weeks after botulinum injection(s) (50 units Dysport in up to 3 sites), and measured mouth opening in mm. Of those treated 49 (79%) showed at least some improvement (pain reduced by more than 25%). Patients reported more than a 90% reduction in the VAS for 25 (30%) of the 84 sides of the face treated. Only 22 of the 62 patients had more than one course of treatment to the same side. Interincisal distance improved by a mean/median of 0.9 mm (p<0.03) after treatment. Side effects included 3 cases of temporary weakness of a facial muscle. Ranking the VAS pain scores using the Wilcoxon test before and after injection showed a significant reduction in pain (median change -29.5, interquartile range -53 to -16, p<0.0001). The treatment significantly improved patients' pain scores and the overall mean/median reduction in pain was 57%. Botulinum injection does not guarantee complete resolution of myofascial pain, but it usually has some beneficial effect in improving the symptoms, and should be considered as an alternate treatment for masticatory myofascial pain if conservative methods have failed.
authors.affiliation: Maxillofacial Unit, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, United Kingdom. ajsidebottom@doctors.org.uk
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Sidebottom
authors.forename: Amish A
authors.initials: AA
authors.lastname: Patel
authors.forename: Janaki
authors.initials: J
authors.lastname: Amin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D005152:Facial Muscles / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008406:Masseter Muscle / Q000187:drug effects; D008410:Masticatory Muscles / Q000187:drug effects*; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D011446:Prospective Studies; D011626:Pterygoid Muscles / Q000187:drug effects; D016059:Range of Motion, Articular / Q000187:drug effects; D013703:Temporal Muscle / Q000187:drug effects; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome; D061028:Trigger Points; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA