Title	Botulinum Toxin Type A Is More Effective Than No Treatment At Reducing Pain Frequency And Severity Due To Trigeminal Neuralgia
Clinical Question	For patients with trigeminal neuralgia, does treating with regular botulinum toxin injections more effectively reduce facial pain episodes compared to no treatment?
Clinical Bottom Line	Botulinum Toxin Type A is more effective than no treatment at reducing pain frequency and severity due to trigeminal neuralgia.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 22492424 Wu/2012 42 adult patients with trigeminal neuralgia RCT Key results BTX-A exceeded placebo for reduction in pain intensity and frequency at 2 weeks following the initial injection and throughout the remaining weeks of the study (p < 0.01). BTX-A also showed to be superior to placebo in reduction of pain attack frequency starting the first week following the initiation of injections and continuing throughout the study (p < 0.01). 20674409 Bohluli/ 2011 15 patients between ages 28 and 67 with trigeminal neuralgia Study Type Case series Key results Up to 6 months following the injections, all 15 patients experienced improvement in frequency and severity of pain. At 1 week and 1 month following the treatment, the ANOVA test showed a significant reduction in frequency of pain (p<0.001). The Friedman test and the Wilcoxon signed-rank test showed a significant reduction in severity and a significant improvement in patient's perception of pain respectively (p<0.001).
Evidence Search	"Trigeminal Neuralgia"[Mesh]) AND "Botulinum Toxins, Type A"[Mesh]
Comments on The Evidence	While the studies found do support that botulinum toxin A is superior to no treatment at all, more randomized controlled trials need to be performed to provide more validity. The Wu article does provide strong validity in that it was a double-blind RCT, however, the patient pool was small and the evidence would be stronger if more patients were tested. The Bohluli article reported lessened pain frequency and intensity for up to 6 months following injections, however, common notion is that botox injections are effective for up to 3 months. More studies are needed to determine the efficacy past 3 months and the long-term effects of regular treatments with Botox.
Applicability	The information in these articles would be applicable to an adult patient living with trigeminal neuralgia looking to reduce pain severity and frequency. It is worth noting, however, that trigeminal neuralgia is a lifetime disorder and treatments would need to be continued regularly to keep the pain under control.
Specialty	(General Dentistry) (Dental Hygiene)
Keywords	Trigeminal neuralgia, pain, botox, botulinum toxin
ID#	2396
Date of submission	02/28/2013
E-mail	Roperle@uthscsa.edu
Author	Lauren Roper
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Edward F. Wright, DDS, MS
Faculty mentor e-mail	WrightE2@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available