Does adjunctive botulinum toxin A reduce pain scores when combined with TMJ arthroscopy for the treatment of concomitant TMJ arthralgia and myofascial pain?

Publication date: Available online 19 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nick Thomas, Sharon Aronovich
IntroductionCurrently, there is no standard of care for the treatment of refractory myofascial pain and concomitant TMJ arthralgia. This comparative study was conducted to determine the effectiveness of botulinum toxin A, as an adjunct to TMJ arthroscopy, in this patient population.Materials & MethodsWe performed a retrospective cohort study of patients who underwent TMJ arthroscopy with (Btx group) or without (control group) intra-muscular botulinum toxin A for TMJ arthritis and refractory myofascial pain at the University of Michigan between 2011 and 2014. For patients in the Btx group, intra-muscular injections of botulinum toxin A were administered at sites of maximal tenderness within the masseter and temporalis muscles. The primary outcome variable was pain score on VAS (0-10). The secondary outcome variables included maximal interincisal opening (MIO), total score for sites of tenderness, total number of tender sites, and diet consistency tolerated. Statistical analysis included means and standard deviations, a student t-test, a simple regression analysis, and multiple regression analysis.ResultsOur study cohort included 52 patients (30 Btx, 22 Control), of which 48 (92.3%) were females. The mean follow-up was 5.56±1.41 months. Patients in the Btx group had a significantly greater reduction in the mean pain score (p=0.04) on VAS compared to the control group (Btx 3.24 vs Control 1.13). On multivariate regression analysis, treatment with Btx trended towards significance (p=0.084) and the pre-operative pain score (p=0.0007) was significantly correlated with the change in pain observed.ConclusionThe use of botulinum toxin A appears to correlate with a clinically superior reduction in pain score compared to the control group. The use of botulinum toxin A may be useful as an adjunctive treatment modality in the management of refractory myofascial pain.



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