Efficacy and Safety of Botulinum Toxin Type A on Persistent Myofascial Pain: A Randomized Clinical Trial

Canales, Giancarlo De la Torre; Alvarez-Pinzon, Natalia; Muñoz-Lora, Victor Ricardo Manuel; Peroni, Leonardo Vieira; Gomes, Amanda Farias; Sánchez-Ayala, Alfonso; Haiter-Neto, Francisco; Manfredini, Daniele; Rizzatti-Barbosa, Célia Marisa

doi:10.3390/toxins12060395

Cited by 46 publications

(70 citation statements)

References 37 publications

(52 reference statements)

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“…Nevertheless, these smaller doses may have limited the appearance of bony changes in the temporomandibular complex. This finding is consistent with recommendations by De la Torre Canales, et al 43 that lower doses of Btx be recommended if considering Btx treatment, since lower doses are associated with lower rates of adverse events.…”

Section: Discussionsupporting

confidence: 92%

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Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

Raphael

Tadinada

Santiago

et al. 2020

J of Oral Rehabilitation

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Background Adverse effects of masticatory muscle injections of Botulinum Toxin (Btx) have been noted in animal and, less dramatically, human studies. Objective Among women treated in multiple community‐based private practices, to compare TMJ bone density and mandibular condylar volume between patients with myofascial TMJD receiving multiple masticatory muscle Btx treatments and similarly diagnosed women not receiving such treatment. Methods Cohorts consisted of women whose treatment charts indicated a diagnosis of myofascial TMJD: 35 received at least 2 Btx treatment cycles; 44 received none. Bone density at pre‐specified regions of interest (ROI) was defined by grey scale values from Cone Beam CT, adjusting for a fixed density phantom included in each scan. Mean bone density and mandibular condyle volume were compared between groups. Dose‐response effects were tested within the Btx‐exposed group. Results The mean density of primary and secondary ROIs was similar between exposure groups, as was condylar volume. Among Btx‐exposed women, increasing dose of Btx to the temporalis muscle was inversely proportional to the density of the trabecular area of the mandible body. Many Btx‐exposed women received smaller doses of Btx to the masseter muscles than in most TMJD Btx clinical trials. Conclusion Masticatory muscle injections of Btx failed to produce clinically significant TMJ bone‐related changes. Should Btx receive regulatory approval for treatment of myofascial TMJD, a phase IV study is recommended to evaluate potential adverse effects of Btx on bone and muscle when administered at higher doses and/or for more treatment cycles.

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Section: Discussionsupporting

confidence: 92%

“…As a community study, the current report revealed a variable use of Btx for myofascial TMJD in a variety of clinical practices. It would appear that masseter muscle Btx dosing is markedly lower in the community than in clinical trials of Btx for myofascial TMJD pain, for example 43 44 .…”

Section: Discussionmentioning

confidence: 99%

Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

Raphael

Tadinada

Santiago

et al. 2020

J of Oral Rehabilitation

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“…Taking into consideration the higher costs compared to other conventional options, the contraindications for women who are pregnant or breastfeeding, and the side effects, BoNT/A will have very little benefit for patients. However, although the patients were older and had a longer disease duration than those in previous studies [25,26,29], the patients showed a much higher improvement in this study. Most studies have evaluated the single use of BoNT/A.…”

Section: Effects Of Bont/a On Myofascial Tmdcontrasting

confidence: 71%

Effects of Botulinum Toxin Type A on Pain among Trigeminal Neuralgia, Myofascial Temporomandibular Disorders, and Oromandibular Dystonia

Yoshida

2021

Toxins

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The differences in analgesic effects of botulinum toxin type A were compared in 28 patients with trigeminal neuralgia, 53 patients with myofascial temporomandibular disorders, and 89 patients with the jaw closing oromandibular dystonia. The patients were treated by injection of botulinum toxin type A into the masseter, temporalis, medial pterygoid, and other muscles based on the symptoms of each patient. The pain severity was evaluated using the visual analog scale, pain frequency, and pain scale of the oromandibular dystonia rating scale. Botulinum toxin injection was performed 1068 times in all patients without significant adverse effects. The visual analog, pain frequency, and pain scales at baseline were reduced (p < 0.001) after two, four, eight, and 12 weeks after the first botulinum toxin therapy and at the endpoint. The effects differed significantly (p < 0.001) among the groups (repeated-measures analysis of variance). The mean improvement (0%, no effect; 100%, complete recovery) at the endpoint was 86.8% for trigeminal neuralgia, 80.8% for myofascial pain, and 75.4% for oromandibular dystonia. Injection of the botulinum toxin can be a highly effective and safe method to treat trigeminal neuralgia, myofascial pain, and oromandibular dystonia.

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“…In this context, the BoNTA intervention resulted in a more deleterious effect at the cortical bone of the mandibular condylar process of postmenopausal women, when compared with premenopausal women ( 192 ). In adult women with myofascial pain, a randomized clinical trial demonstrated a significant reduction of the volume of the mandibular condylar process at 3 months, after a high BoNTA dose injection in both the temporalis (25 U) and the masseter (75 U) muscles but not at lower doses (20 U and 50 U, respectively) ( 193 ). These results are consistent with a cohort study, which showed no bone loss at the mandibular condylar process in adult women with myofascial pain that underwent BoNTA interventions under 40 U in the masseter muscles when compared to match control population ( 194 ).…”

Section: Muscle-bone Crosstalk At the Masticatory System In Health Anmentioning

confidence: 99%

Muscle-Bone Crosstalk in the Masticatory System: From Biomechanical to Molecular Interactions

et al. 2021

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The masticatory system is a complex and highly organized group of structures, including craniofacial bones (maxillae and mandible), muscles, teeth, joints, and neurovascular elements. While the musculoskeletal structures of the head and neck are known to have a different embryonic origin, morphology, biomechanical demands, and biochemical characteristics than the trunk and limbs, their particular molecular basis and cell biology have been much less explored. In the last decade, the concept of muscle-bone crosstalk has emerged, comprising both the loads generated during muscle contraction and a biochemical component through soluble molecules. Bone cells embedded in the mineralized tissue respond to the biomechanical input by releasing molecular factors that impact the homeostasis of the attaching skeletal muscle. In the same way, muscle-derived factors act as soluble signals that modulate the remodeling process of the underlying bones. This concept of muscle-bone crosstalk at a molecular level is particularly interesting in the mandible, due to its tight anatomical relationship with one of the biggest and strongest masticatory muscles, the masseter. However, despite the close physical and physiological interaction of both tissues for proper functioning, this topic has been poorly addressed. Here we present one of the most detailed reviews of the literature to date regarding the biomechanical and biochemical interaction between muscles and bones of the masticatory system, both during development and in physiological or pathological remodeling processes. Evidence related to how masticatory function shapes the craniofacial bones is discussed, and a proposal presented that the masticatory muscles and craniofacial bones serve as secretory tissues. We furthermore discuss our current findings of myokines-release from masseter muscle in physiological conditions, during functional adaptation or pathology, and their putative role as bone-modulators in the craniofacial system. Finally, we address the physiological implications of the crosstalk between muscles and bones in the masticatory system, analyzing pathologies or clinical procedures in which the alteration of one of them affects the homeostasis of the other. Unveiling the mechanisms of muscle-bone crosstalk in the masticatory system opens broad possibilities for understanding and treating temporomandibular disorders, which severely impair the quality of life, with a high cost for diagnosis and management.

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Efficacy and Safety of Botulinum Toxin Type A on Persistent Myofascial Pain: A Randomized Clinical Trial

Cited by 46 publications

References 37 publications

Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

Effects of Botulinum Toxin Type A on Pain among Trigeminal Neuralgia, Myofascial Temporomandibular Disorders, and Oromandibular Dystonia

Muscle-Bone Crosstalk in the Masticatory System: From Biomechanical to Molecular Interactions

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