Evaluating the Effects of Ice Application on Patient Comfort before and after Botulinum Toxin Type A Injections
Patcharin Saeliw MD*, Passorn Preechawai MD*, Nipat Aui-aree MD*
Affiliation : * Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : To evaluate the efficacy of ice application in reducing pain during botulinum toxin type A injections.
Results : Prospective, randomized, single-blind clinical study.
Material and Method: Sixty patients who underwent botulinum toxin A treatment on their faces were included in the present
study, divided into three groups, group1 had ice applied 5 minutes before the injection, group 2 ice was applied 5 minutes after
the injection, and group 3 served as a control, receiving an injection without ice application. A numeric pain distress scale was
used to assess pain intensity. Any complications arising from the injections were also recorded.
Results : Sixty patients were studied between July 2007 and March 2008. The ages ranged from 32 to 76 years (mean, 58.15
+ 10.51 years) and 49 (81.7%) were female. Forty-five (75.0%) had hemifacial spasm and fifteen (25.0%) had blepharospasm.
The numeric pain distress scale was completed immediately after the injections and the results were 3.55 + 1.85, 5.15 + 2.81
and 6.1 + 2.63 in groups 1, 2, and 3 respectively. The ratings indicated that pain was significantly reduced in group 1
compared to group 3 (p = 0.005), but there was not a significant difference between groups 1 and 2 (p = 0.109) or between
groups 2 and 3 (p = 0.448). There was a significant difference in the rate of bleeding after the injections between groups 1 and
2 (p = 0.0472), but no significant difference between groups 1 and 3 (p = 0.106) and groups 2 and 3 (p = 1).
Conclusion : Using an ice application 5 minutes before or after injection showed no difference but both significantly reduce
pain compared to without ice application, while 5-minute application before injection had significantly decreased the bleeding
compared to both 5 minutes after injection and without ice application. The ice application is helpful in pain relief, whereas the
before-injection has lesser bleeding than after-injection modality.
Keywords : Botulinum toxin A, Blepharospasm, Hemifacial spasm, Pain
