Patient-centred evaluation of a reduced dose of botulinum toxin A in the management of myofascial pain

In our previous service evaluation, we reported improvement in patients’ pain scores for masseteric pain and spasm, following injection of 50 units of botulinum toxin A (BtA), measured using visual analogue scales (VAS). We have recently introduced a lower dose BtA protocol, for appropriately select...

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Main Authors: Alice Cameron, Simon Haworth, Jerry N. Farrier
Format: Article
Language:English
Published: Elsevier 2025-03-01
Series:Advances in Oral and Maxillofacial Surgery
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Online Access:http://www.sciencedirect.com/science/article/pii/S2667147625000020
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author Alice Cameron
Simon Haworth
Jerry N. Farrier
author_facet Alice Cameron
Simon Haworth
Jerry N. Farrier
author_sort Alice Cameron
collection DOAJ
description In our previous service evaluation, we reported improvement in patients’ pain scores for masseteric pain and spasm, following injection of 50 units of botulinum toxin A (BtA), measured using visual analogue scales (VAS). We have recently introduced a lower dose BtA protocol, for appropriately selected patients, aimed to evaluate whether this is also effective at relieving symptoms of masseteric pain and spasm. The rationale was to reduce side-effects and costs.VAS scores were measured before and after treatment for 48 patients who received treatment with the original BtA protocol (“Protocol A” - the historical cohort who received 50 units) and for 46 patients who receieved a modified BtA protocol (“Protocol B” - the current cohort who received 25 units).Patients in both treatment groups reported severe symptoms prior to treatment. Patients who received protocol B reported, on average, a 5 unit improvement in VAS following treatment (95 % confidence interval 4.3 to 5.7 improvement in VAS). There was no evidence that protocol B was less effective, despite the lower dose.We recommend a reduced dose of BtA, of 25 units, for injection for appropriately selected patients with masseteric pain and spasm. A lower dose of BtA reduces wastage, particularly for single muscles injection and may reduce the incidence of unwanted side-effects. Reducing the standard dose of BtA will reduce costs for healthcare providers and may therefore facilitate funding for provision of intramuscular injection of BtA, where justified.
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spelling doaj-art-505a5691038743a7a8be9f427e791d372025-01-27T04:22:31ZengElsevierAdvances in Oral and Maxillofacial Surgery2667-14762025-03-0117100515Patient-centred evaluation of a reduced dose of botulinum toxin A in the management of myofascial painAlice Cameron0Simon Haworth1Jerry N. Farrier2Department of Oral and Maxillofacial Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Road, Gloucester, GL1 3NN, United Kingdom; Corresponding author.Bristol Dental School, University of Bristol, Bristol, United KingdomDepartment of Oral and Maxillofacial Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Road, Gloucester, GL1 3NN, United KingdomIn our previous service evaluation, we reported improvement in patients’ pain scores for masseteric pain and spasm, following injection of 50 units of botulinum toxin A (BtA), measured using visual analogue scales (VAS). We have recently introduced a lower dose BtA protocol, for appropriately selected patients, aimed to evaluate whether this is also effective at relieving symptoms of masseteric pain and spasm. The rationale was to reduce side-effects and costs.VAS scores were measured before and after treatment for 48 patients who received treatment with the original BtA protocol (“Protocol A” - the historical cohort who received 50 units) and for 46 patients who receieved a modified BtA protocol (“Protocol B” - the current cohort who received 25 units).Patients in both treatment groups reported severe symptoms prior to treatment. Patients who received protocol B reported, on average, a 5 unit improvement in VAS following treatment (95 % confidence interval 4.3 to 5.7 improvement in VAS). There was no evidence that protocol B was less effective, despite the lower dose.We recommend a reduced dose of BtA, of 25 units, for injection for appropriately selected patients with masseteric pain and spasm. A lower dose of BtA reduces wastage, particularly for single muscles injection and may reduce the incidence of unwanted side-effects. Reducing the standard dose of BtA will reduce costs for healthcare providers and may therefore facilitate funding for provision of intramuscular injection of BtA, where justified.http://www.sciencedirect.com/science/article/pii/S2667147625000020Masseteric hypertrophyBotulinum toxinMyofascial pain
spellingShingle Alice Cameron
Simon Haworth
Jerry N. Farrier
Patient-centred evaluation of a reduced dose of botulinum toxin A in the management of myofascial pain
Advances in Oral and Maxillofacial Surgery
Masseteric hypertrophy
Botulinum toxin
Myofascial pain
title Patient-centred evaluation of a reduced dose of botulinum toxin A in the management of myofascial pain
title_full Patient-centred evaluation of a reduced dose of botulinum toxin A in the management of myofascial pain
title_fullStr Patient-centred evaluation of a reduced dose of botulinum toxin A in the management of myofascial pain
title_full_unstemmed Patient-centred evaluation of a reduced dose of botulinum toxin A in the management of myofascial pain
title_short Patient-centred evaluation of a reduced dose of botulinum toxin A in the management of myofascial pain
title_sort patient centred evaluation of a reduced dose of botulinum toxin a in the management of myofascial pain
topic Masseteric hypertrophy
Botulinum toxin
Myofascial pain
url http://www.sciencedirect.com/science/article/pii/S2667147625000020
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AT simonhaworth patientcentredevaluationofareduceddoseofbotulinumtoxinainthemanagementofmyofascialpain
AT jerrynfarrier patientcentredevaluationofareduceddoseofbotulinumtoxinainthemanagementofmyofascialpain