Poster 344 Botulinum Toxin Versus Fascial Manipulation Technique in the Treatment of Chronic Facial Pain

Design: Thirty patients with a diagnosis of chronic facial pain associated with myofascial syndrome were randomly divided in 2 groups. Participants: 22 women, 8 men; age range, 23-69 years. Interventions: 15 subjects (11 women, 4 men; mean age, 44 years) were treated with botulinum toxin injections (group A) and 15 subjects (11 women, 4 men; mean age, 45 years) were treated with 4 sessions of fascial manipulation technique (group B). Main Outcome Measures: All the patients were assessed with the Research Diagnostic Criteria for Temporomandibular Disorders axis II (intensity of facial pain, limitation of activities of daily living). Results: The group A showed a decrease in pain (from 7.0 to 4.8 of the visual analog scale) and in the masticatory pain (from 3.4 to 1.6). Moreover, botulinum toxin injections permit quitting habits of tooth grinding and clenching. There are no adverse effects with botulinum, further, a “fixed” smile for about 6-8 weeks. In group B, a reduction of pain intensity was evident (from 6.0 to 2.1). Significant differences were found in rest pain between preintervention and both postintervention and 1-month follow-up periods. Besides, all the participants reported reductions in headache frequency and intensity over time, although only in the group B was this improvement statistically significant (88.5%). Surface electromyography measured a decrease of frequency (V) and amplitude of muscle activity in both groups but higher in group A. Conclusions: Results from the present study support the efficacy of BTX-A and fascial manipulation technique to reduce myofascial pain symptoms in bruxism, and it is probably that using both the methods could further improved the outcomes. A larger definitive trial will be needed to confirm this hypothesis.