OnabotulinumtoxinA injections for atypical odontalgia: an open-label study on nine patients

Abstract

Rafael García-Sáez,1 Álvaro Gutiérrez-Viedma1,2 Nuria González-García,1 Víctor Gómez-Mayordomo,1 Jesús Porta-Etessam,1,2 María-Luz Cuadrado1,2 1Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; 2Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain Background: Atypical odontalgia (AO) manifests as continuous pain in the region of one or several teeth, in the absence of signs of dental pathology. Currently, there is insufficient evidence to establish treatment guidelines for AO. The aim of this study was to describe the effectiveness and safety of treatment with OnabotulinumtoxinA (OnabotA) on a series of patients with AO. Methods: Nine patients with AO (four males and five females, aged between 31 and 77 years) received injections of OnabotA in the region of pain. The dosage used in each procedure ranged between 10 and 30 U, spread between 4 and 12 injection sites along the gums (n=9), the lips (n=3), and the hard palate (n=1). The median follow-up time was 27 months (interquartile range, IQR 20–40) and the median number of injection sessions per patient was seven (IQR 4.5–9). The assessment variables included the change in the maximal intensity of pain on a 0–10 numerical rating scale (NRS), the response latency, and the duration of the effect. Results: All patients experienced a significant improvement, with ≥50% of reduction in the intensity of the maximal pain. The median of reduction of maximal pain after treatment was six points on the NRS (IQR 5–8.5). The response latency was 2–15 days and the duration of the effect was 2–6 months. No significant adverse reactions were registered. Conclusion: OnabotA may be a safe and effective option for the treatment of AO. Keywords: neuropathic pain, orofacial pain, painful trigeminal neuropathy, persistent dentoalveolar pain, persistent idiopathic facial pain, phantom tooth pain

Keywords

• Atypical odontalgia
• Neuropathic pain
• OnabotulinumtoxinA
• Orofacial pain
• Painful trigeminal neuropathy
• Persistent idiopathic facial pain.