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Botulinum injection for the management of myofascial pain in the masticatory muscles. A prospective outcome study

  • Andrew J. Sidebottom
    Correspondence
    Corresponding author. Tel.: +44 115 9249924x65895; fax: +44 115 8493386.
    Affiliations
    Maxillofacial Unit, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, United Kingdom
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  • Amish A. Patel
    Affiliations
    Biostatistics and Databases Program, The Kirby Institute for Infection and Immunity in Society, The University of New South Wales, Sydney, Australia
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  • Janaki Amin
    Affiliations
    Biostatistics and Databases Program, The Kirby Institute for Infection and Immunity in Society, The University of New South Wales, Sydney, Australia
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Published:August 06, 2012DOI:https://doi.org/10.1016/j.bjoms.2012.07.002

      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.

      Keywords

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