Botox Helps Patients Face Intractable Facial Pain

Everyone's favorite toxin appears to offer significant relief from severe facial pain.

When Botox (botulinum-A toxin) was injected into the faces of 13 patients with severe, painful symptoms from Trigeminal neuralgia, all had significant reductions in pain, according to researchers here and at Thomas Jefferson Hospital in Philadelphia.

Four of the 13 were able to stop taking pain medications altogether, and the rest were able to reduce their use of pain medications by more than half, reported Elcio Juliato Piovesan, M.D., and colleagues in the Oct. 25 issue of Neurology.

"Drugs are not always effective in treating Trigeminal neuralgia," said Dr. Piovesan, a neurologist at the Clinical Hospital of the Federal University of Parana. "Some patients avoid them because of side effects, and then their pain is more intense and longer-lasting."

To determine the minimal dose for effective treatment of Trigeminal neuralgia and to assess the duration of relief, the authors conducted an open-label study in 13 patients, all of whom met International Headache Society criteria for Trigeminal neuralgia. Four of the patients had symptoms in just one nerve branch of the trigeminal nerve and nine had symptoms in two or more branches.

Patients reported their medication use at baseline and at 60 days post injections. Patients were evaluated at 10, 20, 30 and 60 days following Botox injection.

Trigeminal neuralgia is an extremely painful inflammation of the trigeminal nerve which causes severe lightening-like facial pain on the involved side.

These painful attacks may occur after lightly touching different skin areas of the face, along the course of this cranial nerve. Specific medications can be very effective in reducing the rate of attacks, but surgical intervention may be necessary.

For more information check: Trigeminal neuralgia

All patients at baseline reported severe, painful symptoms that correlated on a visual analog scale with the size of the painful area.

The dose of Botox used depended on the reported pain surface, and ranged from 6.83 to 9.11 units.

"Pain intensity was significantly reduced at the first evaluation after treatment with [Botox] and [the treatment] reached its peak effect at the 20-day evaluation," the authors wrote.

At the 60-day follow-up visit, four patients reported that they were medication free, and the remainder said they had reduced their pain-meds use by more than 50%.

Three patients who took multiple drugs without benefit before Botox injection were taking only one drug at a smaller dosage at last follow-up, the authors noted.