Comparison Between Botox and Magnesium Sulfate Effect in Treatment of Myofascial Pain Trigger Points Within the Masseter Muscle

Summary

The goal of this randomized clinical trial is to compare the effectiveness of Botulinum toxin type A, magnesium sulfate and saline injections in treatment of the masseter muscle trigger points, in patients between 16 - 50 years old with myofascial pain with masseter muscle trigger points. The main questions it aims to answer are: * which treatment has longer effect of pain release with the least possible side effects and recurrence rate? * Which treatment has greater impact on improving patient's quality of life? Researchers will compare Botulinum toxin type A, magnesium sulfate to a placebo saline injections in treatment of the masseter muscle trigger points Participants will attend to the clinic 4 times * 1st visit will include taking preoperative records and treatment injection * 2nd visit will be follow up and taking records after 1 month * 3rd visit will be follow up and taking records after 3 months * 4th visit will be follow up and taking records after 6 months

Timeline

Start

2024-12-01

Primary completion

2025-02

Completion

2025-08

Publications

• Background Zielinski G, Bys A, Szkutnik J, Majcher P, Ginszt M. Electromyographic Patterns of Masticatory Muscles in Relation to Active Myofascial Trigger Points of the Upper Trapezius and Temporomandibular Disorders. Diagnostics (Basel). 2021 Mar 24;11(4):580. doi: 10.3390/diagnostics11040580.
• Background Yilmaz O, Sivrikaya EC, Taskesen F, Pirpir C, Ciftci S. Comparison of the Efficacy of Botulinum Toxin, Local Anesthesia, and Platelet-Rich Plasma Injections in Patients With Myofascial Trigger Points in the Masseter Muscle. J Oral Maxillofac Surg. 2021 Jan;79(1):88.e1-88.e9. doi: 10.1016/j.joms.2020.09.013. Epub 2020 Sep 14.
• Background Taskesen F, Cezairli B. The effectiveness of the masseteric nerve block compared with trigger point injections and dry needling in myofascial pain. Cranio. 2023 Mar;41(2):96-101. doi: 10.1080/08869634.2020.1820686. Epub 2020 Sep 16.
• Background Tantanatip, A. and Chang, K.V., 2018. Myofascial pain syndrome.
• Background Sluka KA, Kalra A, Moore SA. Unilateral intramuscular injections of acidic saline produce a bilateral, long-lasting hyperalgesia. Muscle Nerve. 2001 Jan;24(1):37-46. doi: 10.1002/1097-4598(200101)24:13.0.co;2-8.
• Background Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health. 1994 Mar;11(1):3-11.
• Background Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004 Feb;14(1):95-107. doi: 10.1016/j.jelekin.2003.09.018.
• Background Saxena A, Chansoria M, Tomar G, Kumar A. Myofascial pain syndrome: an overview. J Pain Palliat Care Pharmacother. 2015 Mar;29(1):16-21. doi: 10.3109/15360288.2014.997853. Epub 2015 Jan 5.
• Background Refahee SM, Mahrous AI, Shabaan AA. Clinical efficacy of magnesium sulfate injection in the treatment of masseter muscle trigger points: a randomized clinical study. BMC Oral Health. 2022 Sep 19;22(1):408. doi: 10.1186/s12903-022-02452-3.
• Background Pihut M, Ferendiuk E, Szewczyk M, Kasprzyk K, Wieckiewicz M. The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. J Headache Pain. 2016;17:29. doi: 10.1186/s10194-016-0621-1. Epub 2016 Mar 24.
• Background Nitecka-Buchta A, Walczynska-Dragon K, Batko-Kapustecka J, Wieckiewicz M. Comparison between Collagen and Lidocaine Intramuscular Injections in Terms of Their Efficiency in Decreasing Myofascial Pain within Masseter Muscles: A Randomized, Single-Blind Controlled Trial. Pain Res Manag. 2018 Jun 3;2018:8261090. doi: 10.1155/2018/8261090. eCollection 2018.
• Background Ibrahim NA, Abdel Raoof NA, Mosaad DM, Abu El Kasem ST. Effect of magnesium sulfate iontophoresis on myofascial trigger points in the upper fibres of the trapezius. J Taibah Univ Med Sci. 2021 Jan 19;16(3):369-378. doi: 10.1016/j.jtumed.2020.12.015. eCollection 2021 Jun.
• Background Fiorillo L. Spine and TMJ: A Pathophysiology Report. J Funct Morphol Kinesiol. 2020 Mar 30;5(2):24. doi: 10.3390/jfmk5020024.
• Background Dahle LO, Berg G, Hammar M, Hurtig M, Larsson L. The effect of oral magnesium substitution on pregnancy-induced leg cramps. Am J Obstet Gynecol. 1995 Jul;173(1):175-80. doi: 10.1016/0002-9378(95)90186-8.
• Background Blanco-Rueda JA, Lopez-Valverde A, Marquez-Vera A, Mendez-Sanchez R, Lopez-Garcia E, Lopez-Valverde N. Preliminary Findings of the Efficacy of Botulinum Toxin in Temporomandibular Disorders: Uncontrolled Pilot Study. Life (Basel). 2023 Jan 28;13(2):345. doi: 10.3390/life13020345.
• Background Aikawa Y, Lynch KL, Boswell KL, Martin TF. A second SNARE role for exocytic SNAP25 in endosome fusion. Mol Biol Cell. 2006 May;17(5):2113-24. doi: 10.1091/mbc.e06-01-0074. Epub 2006 Feb 15.

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