title: Cutaneous cooling to manage botulinum toxin injection-associated pain in patients with facial palsy: A randomised controlled trial.
abstract: BACKGROUND
  Botulinum toxin injections are an effective, well-established treatment to manage synkinesis secondary to chronic facial palsy, but they entail painful injections at multiple sites on the face up to four times per year. Cutaneous cooling has long been recognised to provide an analgesic effect for cutaneous procedures, but evidence to date has been anecdotal or weak. This randomised controlled trial aims to assess the analgesic efficacy of cutaneous cooling using a cold gel pack versus a room-temperature Control.
  
  
  METHODS
  The analgesic efficacy of a 1-min application of a Treatment cold (3-5 °C) gel pack versus a Control (room-temperature (20 °C)) gel pack prior to botulinum toxin injection into the platysma was assessed via visual analogue scale (VAS) ratings of pain before, during and after the procedure.
  
  
  RESULTS
  Thirty-five patients received both trial arms during two separate clinic appointments. Cold gel packs provided a statistically significant reduction in pain compared with a room-temperature Control (from 26.4- to 10.2-mm VAS improvement (p < 0.001)), with no variance noted secondary to age, the hemi-facial side injected or the order in which the Treatment or Control gel packs were applied.
  
  
  CONCLUSIONS
  Cryoanalgesia using a fridge-cooled gel pack provides an effective, safe and cheap method for reducing pain at the botulinum toxin injection site in patients with facial palsy.
authors.affiliation: Department of Acute General Medicine, John Radcliffe Hospital, Headley Way, Oxford, UK.
authors.forename: N
authors.initials: N
authors.lastname: Pucks
authors.affiliation: Division of Surgery, Imperial College London, 10th Floor QEQM Building, London, UK; Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK. Electronic address: Dralexisthomas@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Department of Plastic Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hallam
authors.affiliation: Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK.
authors.forename: V
authors.initials: V
authors.lastname: Venables
authors.affiliation: Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK.
authors.forename: C
authors.initials: C
authors.lastname: Neville
authors.affiliation: Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK.
authors.forename: C
authors.initials: C
authors.lastname: Nduka
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D017679:Cryotherapy / Q000379:methods*; D005157:Facial Pain / Q000209:etiology / Q000517:prevention & control*; D005158:Facial Paralysis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D046608:Synkinesis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Analgesia; Botulinum toxin; Cryoanalgesia; Facial nerve palsy; Pain; Synkinesis