We prospectively analysed the outcome after botulinum injection in patients who did not recover after conservative measures to manage masticatory myofascial
pain, and who were not willing to take low dose
tricyclic antidepressants as a muscle relaxant. We prospectively 62 patients were assessed with visual analogue scores (VAS) for
pain on the affected side before, and 6 weeks after botulinum injection(s) (50 units
Dysport in up to 3 sites), and measured mouth opening in mm. Of those treated 49 (79%) showed at least some improvement (
pain reduced by more than 25%). Patients reported more than a 90% reduction in the VAS for 25 (30%) of the 84 sides of the face treated. Only 22 of the 62 patients had more than one course of treatment to the same side. Interincisal distance improved by a mean/median of 0.9 mm (p<0.03)
after treatment. Side effects included 3 cases of temporary weakness of a facial muscle. Ranking the VAS
pain scores using the Wilcoxon test before and after injection showed a significant reduction in
pain (median change -29.5, interquartile range -53 to -16, p<0.0001). The treatment significantly improved patients'
pain scores and the overall mean/median reduction in
pain was 57%. Botulinum injection does not guarantee complete resolution of myofascial
pain, but it usually has some beneficial effect in improving the symptoms, and should be considered as an alternate treatment for masticatory myofascial
pain if conservative methods have failed.