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Who Owns YOUR TMJ Implant?

Especially during this past year, it’s been brought to our attention by a number of TMJ implant patients having their implants removed that...

Social Security Disability Benefits and Temporomandibular Disorders

Those who suffer from Temporomandibular Disorders also referred to as TMJ or TMD, may find it impossible to maintain the responsibilities...

Pain Sensitivity and Genetic Factors: Act Two of the OPPERA Study

This month we present the last set of findings from “Act Two” of the Oral Pain: Prospective Evaluation and Risk Assessment (OPPERA)...

Symptoms, Sociodemographics, & Psychological Profile: Act Two of the OPPERA Study

Last month we began our report on findings in OPPERA's Act Two," the second series of analyses of data from the Orofacial Pain Prospective...

Temporomandibular Disorders and Sexual Intimacy

A recent posting on the TMJA website included the following request: "I wonder if you could include something in a future newsletter about...

Botox & Myofascial TMJ Pain Study

Jul 15, 2011

Our sincere thanks to Dr. Susan Herring of the University of Washington in Seattle  for providing the following summary of a recent article in the profressional journal, Pain.

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.
In press, Pain (2011), doi:10.1016/j.pain.2011.03.036.
Botox blocks the release of neurotransmitters from nerve endings.  Although chiefly used to stop muscle contraction, it might also relieve pain by preventing nerves from releasing inflammatory molecules. This clinical trial investigated whether Botox injection of the masseter was an effective treatment for patients with persistent myofascial TMJ pain.
The 21 patients (19 female) all met rigorous criteria and were recruited from 4 Danish and Swedish clinics. The study was very well-controlled in that (1) patients served as their own controls and were injected twice, once with Botox and once with saline, but in random order (crossover design) and (2) investigators as well as subjects were blinded as to which substance was injected (double blinding).  Patients were carefully examined for pain and other variables 1 month and 3 months after the injections.

Side effects reported in the first week after injections included headache and fatigue, but were similar for Botox and saline; side effects were gone by 1 month. This suggests that subjects were not able to tell which injection was the Botox.

Surprisingly, pain intensity was reduced after both Botox and saline injections, although more so for Botox.  However, the number of patients that experienced significant (defined as 30% decrease) pain reduction was about the same for both treatments.

The investigators concluded that there was a strong placebo effect, which means that less well-controlled studies may not be valid. While there was a slightly better outcome for Botox than for saline, it was small and was not experienced by all patients.  The authors recommended against the use of Botox as an adjunct to conservative treatment of persistent myofascial pain on the basis of its high cost and lack of efficacy. 

©2011 The TMJ Association, Ltd. All rights

Chronic Pain Research Alliance

Current Research shows these conditions frequently coexist, overlapping with TMJ Disorders

  • Chronic Fatigue Syndrome
  • Endometriosis
  • Fibromyalgia
  • Vulvodynia
  • Interstitial Cystitis
  • Irritable Bowel Syndrome

Why Is That?

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