Botulinum Toxin, Lidocaine, and Dry-Needling Injections in Patients with Myofascial Pain and Headaches

Abstract

Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain (MFP) patient management. However, few studies have analyzed their effect in a chronic headache population with associated MFP. The purpose of this study was to assess if trigger point injections using botulinum toxin, lidocaine, and dry-needling injections for the management of local pain and associated headache management. Forty-five (45) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point, were randomly assigned into one of the three groups: G1, dry-needling, G2, 0.25% lidocaine, at 0.25% and G3 botulinum toxin and were assessed during a 12 week period. Levels of pain intensity, frequency and duration, local post-injection sensitivity, obtainment time and duration of relief, and the use of rescue medication were evaluated. Statistically, all the groups showed favorable results for the evaluated requisites (p≤0.05), except for the use of rescue medication and local post injection sensitivity (G3 showed better results). Considering its reduced cost, lidocaine could be adopted as a substance of choice, and botulinum toxin should be reserved for refractory cases, in which the expected effects could not be achieved, and the use of a more expensive therapy would be mandatory.

Additional information

Notes on contributors

Roberta de Abreu Venancio

Dr. Roberta Venancio received her D.D.S. degree from the Araraquara School of Dentistry, São Paulo State University, Brazil in 2000, a masters degree in oral rehabilitation in 2003, and a Ph.D. degree in 2005 from the same institution. Currently, she treats orofacial pain patients in a private practice in Brazil.

Francisco Guedes Pereira Alencar

Dr. Francisco Alencar, Jr. received his D.D.S. degree in 1987 from the Bauru School of Dentistry, University of São Paulo, Brazil, as well as M.S. and a Ph.D. degrees from the same university. In 2002, he received a M.S. degree in dentistry (TMD and orofacial pain program) at the University of Minnesota School of Dentistry, Minneapolis. Currently, he is an assistant professor, teaching occlusion, TMD, and orofacial pain related disciplines, at the General Dental Sciences Department, Marquette University School of Dentistry, Milwaukee, Wisconsin.

Camila Zamperini

Dr. Camila Zamperini received her D.D.S. degree from the Araraquara School of Dentistry, São Paulo State University in 2006. Currently, she is a M.S. candidate in the Prosthodontics Graduate Program at the same university.