The Effect of BotulinumToxin-A Injections on the Quality of Life of Patients with Myofacial Pain

Abstract

Objective The aim of this study was to evaluate the impact of botulinum toxin type A (BTX-A) injections on chronic pain and quality of life of patients with temporomandibular myofacial pain. Material-Method This study was carried out on 76 individuals presenting with clinically myofacial pain according to The Diagnostic Criteria for Temporomandibular Disorders. All patients were injected with 30 U of BTX-A for the masseter muscle per side and 20U of BTX-A for the temporal muscle per side. A 10-cm visual analog scale and OHIP-TMDs questionnaire were used to assess pain severity and quality of life in patients with myofacial pain respectively before and six months after BTX-A injections. Changes in quality of life and pain severity were corralated with age, gender, education level and employment status. Results A statistically significant improvement in pain and OHIP-TMDs scores were found six months after BTX-A injections, regardless of gender, age, education level and employment status (p≤0.05). A significant positive correlation was observed between patients’ self-reporting capability when answering questions on self-rated quality of life and education level and/or employment before and after BTX-A injections (p≤0.05). Higher educational levels and/or employment status were found to be related with higher OHIP-TMD scores after treatment (p≤0.05). Conclusion Patients with myofacial pain presented significant improvements in pain and quality of life scores 6 months after BTX-A injections. This form of therapy seem promising for patients to provide improvement in quality of life and as well as clinical parameters.

Keywords

• Facial Pain
• Temporomandibular Joint Disorders
• Botulinum Toxins Type A
• Quality of Life

Miyofasiyal Ağrılı Hastalarda Botulinum Toksin-A Enjeksiyonunun Yaşam Kalitesi Üzerindeki Etkilerinin Değerlendirilmesi

Abstract

Amaç Bu çalışmanın amacı, temporomandibular miyofasiyal ağrısı olan hastalarda, botulinum toksin-A (BTX-A) enjeksiyonunun kronik ağrı üzerindeki etkisi ile birlikte yaşam kalitesindeki iyileşmeyi değerlendirmekti. Materyal-Metot Çalışmaya Temporomandibular Düzensizlikler İçin Tanı Kriterleri’ne göre yalnızca miyofasiyal ağrı tanısı alan 76 hasta çalışmaya dahil edildi. Tüm hastalarda Massater ve Temporal kaslara sırasıyla tek tarafa 30U/0.6mL ve 20U/0.4mL olmak üzere bilateral olarak BTX-A enjeksiyonu yapıldı. BTX-A enjeksiyonunun myofasiyal ağrılı hastaların yaşam kalitesi üzerindeki etkisi, OHIP-TMDs anketi kullanılarak ölçüldü. Hastalar enjeksiyondan önce, ve enjeksiyondan 6 ay sonra hem anketlere hem de ağrı düzeyinin değerlendirmesinde kullanılan görsel analog skalaya cevap verdiler. Yaşam kalitesindeki değişim ile yaş, cinsiyet, eğitim düzeyi ve iş yaşantısı gibi faktörler arasındaki ilişkiler değerlendirildi. Bulgular BTX-A enjeksiyonlarından 6 ay sonra cinsiyet, yaş, eğitim düzeyi ve istihdam durumu farkı gözetmeksizin OHIP-TMDs ve VAS skorlarında iyileşme yönünde istatistiksel olarak anlamlı fark kaydedildi (p≤0,05). BTX-A enjeksiyonu öncesi ve sonrasında, hastaların dereceleme türü tepki kategorileri ile anket sorularını cevaplayarak bireysel yaşam kalitesinin raporlayabilme kabiliyeti ile eğitim düzeyi ve iş yaşantısı arasında anlamlı pozitif korelasyon kaydedildi (p≤0,05). Hastaların eğitim düzeyinin artması ve iş yaşamına sahip olunması ile BTX-A enjeksiyonu sonrası daha yüksek yaşam kalite skorları arasında istatistiksel olarak anlamlı ilişki gözlendi (p≤0,05). Sonuç Miyofasiyal ağrı sendromu hastalarında ağrı düzeyi ve yaşam kalitesinde BTX-A enjeksiyonlarından 6 ay sonra anlamlı düzeyde iyileşme kaydedildi. Bu tedavi şekli, yaşam kalitesinde ve klinik parametrelerde iyileşme sağlaması ile hastalar için umut vericidir.

Keywords

• Fasiyal ağrı
• Temporomandibular Eklem Bozuklukları
• Botulinum Toksinler A Tipi
• Yaşam Kalitesi

References

1. 1- De Leeuw R. Temporomandibular Disorders. In:De Leeuw R editor. American Academy of Orofacial Pain. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 4thed. Chicago; Quintessence: 2008. p. 129–175.
2. 2- La Touche R, Goddard G, De-la-Hoz JL, Wang K, Paris-Alemany A, Angulo-Díaz-Parreño S, et al. Acupuncture in the treatment of pain in temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials. Clin J Pain 2010;26(6):541–50.
3. 3- Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: A systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112(4):453-62.
4. 4- Miller DB. Clinical management of chronic TMD pain. Funct Orthod. 1998;15(3):35–9.
5. 5- Sherman JJ, Turk DC. Nonpharmacologic approaches to the management of myofascial temporomandibular disorders. Curr Pain Headache Rep 2001;5(5):421–31.
6. 6- Herb K, Cho S, Stiles MA. Temporomandibular joint pain and dysfunction. Curr Pain Headache Rep 2006;10(6):408–14.
7. 7- Stohler CS. Clinical perspectives on masticatory and related muscle disorders. In: Sessle BJ, Bryant PS, Dionne RA. Temporomandibular Disorders and Related Pain Conditions: Progress in Pain Research and Management, vol 4. Seattle: WA: IASP Press, 1995:3–29.
8. 8- Dick B, Rashiq S, Zhang J, Ohinmaa A. The impact of chronic pain on quality of life. Can J Anaesth 2007;54: 44579.

9. 9- Almoznino G, Zini A, Zakuto A, Sharav Y, Haviv Y, Hadad A, et al. Oral health- related quality of life in patients with temporomandibular disorders. J Oral Facial Pain Headache 2015;29(3):231–41.
10. 10- Breton-Torres I, Trichot S, Yachouh J, Jammet P. Temporomandibular joint disorders: Physiotherapy and postural approaches. Rev Stomatol Chir Maxillofac 2016;117(4):217–22.
11. 11- Fernandes AC, Duarte Moura DM, Da Silva LGD, De Almeida EO, Barbosa GAS. Acupuncture in Temporomandibular Disorder Myofascial Pain Treatment: A Systematic Review.J Oral Facial Pain Headache 2017 ;31(3):225-32.
12. 12- Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxintype A. Neurotoxicology 2005;26(5):785–93. 
13. 13- Shofiq I. Botulinum toxin in the management of masticatory myalgia: a meta- analysis of randomised controlled studies. Br J Oral Maxillofac Surg 2016;54(10):145–6.
14. 14- Freund B, Schwartz M, Symington JM. Botulinum toxin: new treatment for temporomandibular disorders. Br J Oral Maxillofac Surg 2000;38(5):466–71.
15. 15- Schiffman E, Ohrbach R, Truelove E, Look J, List T, Svensson P, Gonzalez Y, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Orofac Pain 2014;28:6–27.
16. 16- Ohrbach R, editor. Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments. Version 15May2016. [Temporomandibuler Düzensizlikler için Teşhis Kriterleri: Değerlendirme Araçları: Turkish Version 25May2016]. Polat S, Polat NT, Çetinoğlu A, Saleh MS, Ünal S, Yolcu Ü, Tatar T, Trans. [cited 2020 Aug 20]. Available from: www.rdc-tmdinternational.org
17. 17- Durham J, Steele JG, Wassell RW, et al. Creating a patient-based condition-specific outcome measure for Temporomandibular Disorders (TMDs): Oral Health Impact Profile for TMDs (OHIP-TMDs). J Oral Rehabil 2011;38(12):871-83.
18. 18- Yamazaki M, Inukai M, Baba K, John MT. Japanese version of the Oral Health Impact Profile (OHIP-J). J Oral Rehabil 2007;34(3):159–68.
19. 19- Reisine S, Locker D. Societal, psychological, and economic impacts of oral conditions and treatments. In: Cohen LK, Gift HC. Disease Prevention and Oral Health Promotion. Copenhagen;Munksgaard: 1995:33–71.
20. 20- Tjakkes GH, Reinders JJ, Tenvergert EM, Stegenga B. TMD Pain: The Effect on Health Related Quality of Life and the Influence of Pain Duration. Health Qual Life Outcomes. 2010;8(1):46.
21. 21- Van Der Meulen MJ, John MT, Naeije M, Lobbezoo F. Developing Abbreviated OHIP Versions for Use with TMD Patients. J Oral Rehabil 2012;39(1):18-27.
22. 22-  Butts R, Dunning J, Perreault T, Mettille J, Escaloni J. Pathoanatomical cha- racteristics of temporomandibular dysfunction: Where do we stand? J Bodyw Mov Ther 2017;21(3):534–40.
23. 23- Fernandez-de-Las-Penas C, Galan-Del-Rio F, Alonso-Blanco C, Jimenez-Garcia R, Arendt-Nielsen L, Svensson P. Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporo- mandibular disorders. J Pain 2010;11(12):1295–304.
24. 24-  Meyer HP. Myofascial pain syndrome and its suggested role in the pathogenesis and treatment of fibromyalgia syndrome. Curr Pain Headache Rep 2002;6(4):274–83.
25. 25- Miettinen O, Lahti S, Sipilä K. Psychosocial Aspects of Temporomandibular Disorders and Oral Health-Related Quality-of-Life. Acta Odontol Scand 2012;70(4): 331-6.
26. 26- John MT, Reissmann DR, Schierz O, Wassell RW. Oral Health-Related Quality of Life in Patients with Temporomandibular Disorders. J Orofac Pain 2007;21(2):46-54.
27. 27- Denglehem C, Maes J-M, Raoul G, Ferri J. Botulinum toxin A: analgesic treatment for temporomandibular joint disorders. Rev Stomatol Chir Maxillofac 2012;113(1):27–31.
28. 28- Aynalı G , Yener M . Temporomandibular Eklem Bozukluklarında Tedavi Seçenekleri. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2012;3(3):150-4.
29. 29- Villa S, Raoul G, Machuron F, Ferri J, Nicot R. Improvement in quality of life after botulinum toxin injection for temporomandibular disorder. J Stomatol Oral Maxillofac Surg 2019;120(1):2–6.
30. 30- Reissmann DR, John MT, Schierz O, Wassell RW. Functional and Psychosocial Impact Related to Specific Temporomandibular Disorder Diagnoses. J Dent 2007;35(8):643-50.
31. 31- He SL, Wang JH. Validation of the Chinese Version of the Oral Health Impact Profile for TMDs (OHIP-TMDs-C). Medicina Oral, Patologia Oral Y Cirugia Bucal 2015;20(2):161-6.
32. 32- Wira VV, Pragustine Y, Himawan LS, Ariani N, Tanti I. Relationship between Chronic Pain Severity and Quality of Life in TMD Patients. Journal of International Dental and Medical Research, 2018;11(1): 215-9.
33. 33- De Barros VM, Seraidarian PI, Cortes MI, de Paula LV. The impact of orofacial pain on the quality of life of patients with temporomandibular disorder. J Orofac Pain 2009;23(1):28–37.