A recent study in Pain. 2011 Apr 21 looked at botulinum toxin type A for treatment of persistent myofascial TMD pain. Saline was used as the placebo-control in this double blind study. The crossover study examined 21 patients Myofascial TMD with inadequate pain control.
The study was done to evaluate the effectiveness of botulinum toxin type A for treatment of persistent myofascial TMD pain but actually showed that Saline is normally considered an excellent placebo because there are no direct biological changes associated with saline. There was statistically no advantage to botulinum toxin type A over saline.
I hypothesize that the improvement in pain showed in the study with saline was a direct result of the injection, not what was injected. Dry needling has also been shown to be very effective treatment for myofascial trigger points associated with TMD. I utilize both dry needling and lidocaine injections for treating MPD. Treatment of myofascial trigger points is an extremely effective treatment for TMD pain.
Trigger Point Injections and Dry Needling remain on of the most effective treatments for myofascial TMD.
Pain. 2011 Apr 21. [Epub ahead of print]
Efficacy of botulinum toxin type A for treatment of persistent myofascial TMD pain: a randomized, controlled, double-blind multicenter study.
Ernberg M, Hedenberg-Magnusson B, List T, Svensson P.
Unit of Clinical Oral Physiology, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE 141 04 Huddinge, Sweden.
Evidence of an effect by botulinum toxins is still lacking for most pain conditions. In the present randomized, placebo-controlled, crossover multicenter study, the efficacy of botulinum toxin type A (BTX-A) was investigated in patients with persistent myofascial temporomandibular disorders (TMD). Twenty-one patients with myofascial TMD without adequate pain relief after conventional treatment participated. A total of 50 U of BTX-A or isotonic saline (control) was randomly injected into 3 standardized sites of the painful masseter muscles. Follow-up was performed after 1 and 3months, followed by a 1-month washout period, after which crossover occurred. Pain intensity at rest was the primary outcome measure, while physical and emotional function, global improvement, side effects, and clinical measures were additional outcome measures. There was no main difference between drugs (ANOVA; P=.163), but there was a significant time effect (P<.001), so BTX-A reduced mean (SD) percent change of pain intensity by 30 (33%) after 1month and by 23 (30%) after 3months compared to 11 (40%) and 4 (33%) for saline. The number of patients who received a 30% pain reduction was not significantly larger for BTX-A than after saline at any follow-up visit. The number needed to treat was 11 after 1month and 7 after 3months. There were no significant changes after treatment in any other outcome measures, with the exception of pain on palpation, which decreased 3months after saline injection (P<.05). These results do not indicate a clinical relevant effect of BTX-A in patients with persistent myofascial TMD pain. Botulinum toxin type A is not an effective adjunct to conventional treatment in persistent myofascial temporomandibular disorders.
Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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