Clinical benefit of botulinum toxin for treatment of persistent TMD-related myofascial pain: A randomized, placebo-controlled, cross-over trial.

IF 2.5 3区医学 Q2 ANESTHESIOLOGY Pain Practice Pub Date : 2024-11-01 Epub Date: 2024-07-04 DOI:10.1111/papr.13396

V Sitnikova, A Kämppi, L Kämppi, E Alvesalo, M Burakova, P Kemppainen, O Teronen

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Abstract

Background: Injections of botulinum toxin type A (BoNT-A) have been proposed as an additional treatment modality for patients suffering chronic temporomandibular disorder (TMD)-related myofascial pain (MFP). BoNT-A impairs muscle function, along with its analgesic effect, and a minimal effective dose should be used. The objective of this randomized placebo-controlled crossover study was to evaluate the clinical benefit of a moderate dose (50 U) of BoNT-A.

Methods: Sixty-six subjects were randomized into two groups, one which received BoNT-A first and a second which received a saline solution (SS) first. Follow-ups were performed 2, 11, and 16 weeks after the injections. Diagnostic criteria for temporomandibular disorders (DC/TMD) diagnostic algorithms were used to evaluate characteristic pain intensity (CPI) and pain-related disability based on the Graded Chronic Pain Scale (GCPS). Electromyographic and bite force were also evaluated.

Results: The within-group analysis showed a significant improvement in pain intensity and pain-related disability after BoNT-A (p < 0.001, p = 0.005, p = 0.011) and SS (p = 0.003, p = 0.005, p = 0.046) injections up to week 16. The between-group analysis of pain-related variables revealed no differences between groups at any time. Nonetheless, BoNT-A, but not SS, caused a significant decline in muscle performance. The number needed to treat (NNT) regarding a clinically significant pain reduction (≥30%) was 6.3, 57.0, and 19.0 at 2, 11, and 16-week follow-ups favoring BoNT-A.

Conclusions: Injections of 50 U of BoNT-A might improve MFP symptoms, but the specific effect of the drug on pain compared to the placebo is not obvious.

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肉毒杆菌毒素治疗持续性 TMD 相关肌筋膜疼痛的临床疗效：随机、安慰剂对照、交叉试验。

背景：有人建议将注射 A 型肉毒毒素（BoNT-A）作为慢性颞下颌关节紊乱症（TMD）相关肌筋膜疼痛（MFP）患者的一种额外治疗方式。BoNT-A 在镇痛的同时也会损害肌肉功能，因此应使用最小有效剂量。这项随机安慰剂对照交叉研究的目的是评估中等剂量（50 U）BoNT-A 的临床疗效：66名受试者被随机分为两组，一组先接受BoNT-A治疗，另一组先接受生理盐水（SS）治疗。注射后 2 周、11 周和 16 周进行随访。采用颞下颌关节紊乱诊断标准（DC/TMD）诊断算法，根据慢性疼痛分级量表（GCPS）评估特征疼痛强度（CPI）和疼痛相关残疾。此外，还对肌电图和咬合力进行了评估：组内分析显示，注射 BoNT-A 后，疼痛强度和疼痛相关致残率均有显著改善（p 结论：BoNT-A 对疼痛强度和疼痛相关致残率有显著改善：注射 50 U BoNT-A 可改善 MFP 症状，但与安慰剂相比，该药物对疼痛的具体影响并不明显。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pain Practice ANESTHESIOLOGY-CLINICAL NEUROLOGY

CiteScore

5.60

自引率

3.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Pain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain and analgesia that provide its readership with up-to-date research, evaluation methods, and techniques for pain management. Special sections including the Consultant’s Corner, Images in Pain Practice, Case Studies from Mayo, Tutorials, and the Evidence-Based Medicine combine to give pain researchers, pain clinicians and pain fellows in training a systematic approach to continuing education in pain medicine. Prior to publication, all articles and reviews undergo peer review by at least two experts in the field.