title: Botulinum toxin therapy for hyperhidrosis: reduction of injection site pain by nitrous oxide/oxygen mixtures.
abstract: Injection site pain (ISP) reduces compliance of botulinum toxin (BT) therapy considerably. We wanted to study whether nitrous oxide/oxygen (NOO, Livopan(®), Linde Gas Therapeutics, Unterschleißheim, Germany) can reduce ISP in patients receiving intracutaneous BT injections for axillary or palmar hyperhidrosis (HH). The study followed an open-label design comparing intraindividually ISP in both axillae and/or both palms when NOO was applied or not during BT injections. BT efficacy was measured by the Hyperhidrosis Disease Severity Scale (HDSS) and by a 4-point Self-Assessment Scale. ISP was documented by a Visual Analogue Scale (VAS) and the Verbal Scale of Pain Intensity (VSPI), adverse effects by a Structuralised Interview (SI). Altogether 13 patients (age 34.1 ± 12.4 years, 9 females, 4 males) were studied. 11 BT treatments were for biaxillary and 3 for bipalmar HH. BT reduced biaxillary HH from HDSS 3.7 ± 0.5 to 1.0 ± 0 and bipalmar HH from 3.6 ± 0.6 to 1.0 ± 0. All patients reported ISP reduction by NOO. In axillary HH, NOO reduced ISP from 55.7 ± 12.7 to 12.8 ± 7.5 on the VAS (p < 0.05) and from 4.1 ± 0.3 to 0.7 ± 0.5 on the VSPI (p < 0.05), in bipalmar HH from 60.0 ± 10.0 to 13.3 ± 5.8 on the VAS (p < 0.05) and from 5.0 ± 0 to 1.3 ± 0.5 on the VSPI (p < 0.05). Adverse effects were not identified. NOO is a potent, non-sedative, quickly reversible and safe inhalative analgesic which reduces ISP considerably in patients receiving BT therapy for axillary and palmar HH thus substantially improving compliance of BT therapy.
authors: Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors: Lejla
authors: L
authors: Paracka
authors: Katja
authors: K
authors: Kollewe
authors: Reinhard
authors: R
authors: Dengler
authors: Dirk
authors: D
authors: Dressler
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D001365:Axilla; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy* / Q000503:physiopathology; D007271:Injections, Intradermal / Q000009:adverse effects; D008297:Male; D009609:Nitrous Oxide / Q000627:therapeutic use*; D010100:Oxygen / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D010147:Pain Measurement; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D003879:Dermatologic Agents; D001905:Botulinum Toxins; D009609:Nitrous Oxide; D010100:Oxygen
references: J Neurol. 2001 Apr;248 Suppl 1:31-3
references: 11357238
references: Dermatol Surg. 2006 Jun;32(6):873-4
references: 16792662
references: ISRN Dermatol. 2014 Feb 06;2014:308650
references: 24891956
references: Dermatol Surg. 2007 Aug;33(8):908-23
references: 17661933
references: Expert Opin Drug Saf. 2007 Sep;6(5):559-71
references: 17877443
references: Br J Dermatol. 2004 Dec;151(6):1115-22
references: 15606505
references: J Am Acad Dermatol. 2004 Sep;51(3):345-8
references: 15337974
references: J Am Acad Dermatol. 2004 Aug;51(2):241-8
references: 15280843