Abstract
Botulinum toxin type A (BTA) injection is considered an available alternative treatment for myofascial pain. However, its efficacy in treating masticatory myofascial pain syndrome (MMPS) remains unclear. The purpose of this study was to evaluate whether the BTA injection into the affected muscles would significantly reduce pain and improve function, and to assess its efficacy, safety, and therapeutic indications in a randomized, single-center clinical trial. Sixty patients with MMPS were randomized into three groups evenly to receive a single session injection of saline solution (SS group), lidocaine (LD group), and BTA (BTA group) in the masseter, temporal, and pterygoid muscles after an electromyographic study. Patients’ pain was classified as localized or referred according to the DC/TMD classification. Assessments were performed on pre-treatment, and subsequently, on days 7, 14, 28, 60, 90, and 180. A significant reduction in pain and improvement of mandibular movements was found in the BTA group compared to the SS and LD groups. The response lasted until day 180 and was more intense in patients with localized myalgia and focused myofascial pain than in referred remote pain. No significant adverse reactions were observed. A single BTA injection can be considered an effective treatment option in patients with localized MMPS by reducing pain and improving mandibular movements, which persisted up to 6 months.
Highlights
IntroductionA prime feature of the condition is the existence of trigger points (TrPs), which are areas within the affected muscles that, when stimulated by pressure, cause muscle pain locally or a transfer of pain through radiation to nearby areas of the craniofacial anatomy such as teeth or temporo-mandibular joint (TMJ), producing what is known as referred pain [2]
Myofascial pain syndrome is a complex disorder of the musculoskeletal system with multifactorial involvement and diverse clinical presentations in several areas of the body [1].It can affect the oro-cranio-facial region, with involvement of the temporomandibular area and masticatory muscles, and is called masticatory myofascial pain syndrome (MMPS).A prime feature of the condition is the existence of trigger points (TrPs), which are areas within the affected muscles that, when stimulated by pressure, cause muscle pain locally or a transfer of pain through radiation to nearby areas of the craniofacial anatomy such as teeth or temporo-mandibular joint (TMJ), producing what is known as referred pain [2]
The local twitch response is a characteristic finding of MMPS; it is activated by pressure, palpation, or needle insertion at TrPs and is manifested by a burst of activity in the muscle band that contains the activated point
Summary
A prime feature of the condition is the existence of trigger points (TrPs), which are areas within the affected muscles that, when stimulated by pressure, cause muscle pain locally or a transfer of pain through radiation to nearby areas of the craniofacial anatomy such as teeth or temporo-mandibular joint (TMJ), producing what is known as referred pain [2]. Some parafunctional habits, such as bruxism, have a significant influence in the pathogenesis and perpetuation of this syndrome. Referred myofascial pain (RP) is characterized by extension of the soreness and discomfort towards areas distant from the area identified in the examination and from the limits of the palpated muscle [6]
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