COMPARATIVE STUDY BETWEEN BOTULINUM TOXIN A AND PLATELET RICH PLASMA IN THE TREATMENT OF MYOFASCIAL PAIN WITHIN MASSETER MUSCLE (A RANDOMIZED CLINICAL TRIAL)

Abstract

INTRODUCTION: Masticatory myofascial trigger points (TrPs) are considered from the main sources of pain of non-dental origin in orofacial area. Intramuscular injections are believed to be the standard therapy of myofascial TrPs. Botulinum toxin A (BTX-A) may relieve myofascial pain through inhibition of α-motor nerve endings and blocking nociceptor transduction. Platelet rich plasma (PRP) injection into the masseter muscle is a new treatment which aids in the relief of pain owing to its analgesic and anti-inflammatory effect. OBJECTIVE: To evaluate and compare the effectiveness of BTX-A and PRP injections on muscle activity, visual analogue scale (VAS) for pain, pressure pain intensity (PPI) and jaw functional limitation scale (JFLS) in patients having myofascial TrPs within the masseter muscle. MATERIALS AND METHODS: Twenty six patients suffering from myofascial TrPs within the masseter muscle were selected and randomized into two groups: Group 1 (n=13) received BTX-A injection and group 2 (n=13) received PRP injection. Muscle activity during rest and during function were determined after 6 months, VAS for pain, PPI and JFLS scores were determined at the 1, 3 and 6-months follow-up visits. RESULTS: There was significant improvement seen in both groups at the 1-month follow-up. BTX group exhibited significant changes regarding VAS, PPI and JFLS scores at the 3-months follow-up, while PRP group showed significant changes regarding VAS and JFLS only. At the 6-months follow-up, both groups’ patients relapsed to initial records. CONCLUSION: This study showed that BTX has superior results when compared to PRP in alleviation of myofascial pain. However, patients need to repeat BTX injection every 6 months to restore its effect.