Myalgia

Myofascial Pain

Intramuscular injection with Botulinum toxin type A in m.masseter and m.temporalis.

Botulinum toxin type A

Intramuscular injection with NaCl in m.masseter and m.temporalis.

saline solution

Masseter Myofascial Pain Relief Following an Intra-muscular Injection With Botulinum Toxin Type A.

Masseter Myofascial Pain Relief Following an Intra-muscular Injection With Botulinum Toxin Type A: A Randomized Double-blind Controlled Multicenter Pilot Study

The change in frequency (number) of pain days

Change in average pain intensity by answering the question: "In the past two weeks", on the average, how intense was your pain rated on a 0-10 scale where 0 is "no pain" and 10 "pain as bad as could be" (That is, your usual jaw pain at times you were experiencing pain)".

Change of pain intensity at maximal opening of the jaw. The subject will assess their jaw pain on maximal opening on a numeric rating scale 0-10, where 0 is no pain and 10 is worst pain imaginable.

Change in physical function: Jaw functional problems will be evaluated using the 20-item global Jaw Functional Limitation Scale (JFLS-20), with possible mean scores ranging from 0-10, where 0 i no limitation and 10 is severe limitation.

Change in emotional function using the Patient Health Questionnaire-9 (PHQ-9), a multipurpose instrument used for screening, diagnosing and measuring depression severity, with possible scores ranging from 0-27, where higher scores indicate more severity.

Global improvement. At the follow-up visit the subjects will rate the change in their overall status since beginning the study treatment using the Patient Global Impression of Change (PGIC) scale, a 7-point scaled instrument ranging from "very much improved" to "very much worse"

Change in the Graded Chronic Pain Scale, GCPS, pain and its consequences. GCPS assesses 2 dimensions of overall chronic pain severity: pain intensity and pain-related disability. For pain intensity a numeric rating scale 0-10 is used, where 0 is no pain and 10 is worst pain imaginable. For pain-related disability a numeric rating scale from 0-10 is used where 0 is 'no interference' and 10 is 'extreme change'.

Region Örebro County

Region Västmanland

Landstinget i Värmland

In Real NIBS arm, active Noninvasive brain stimulation (NIBS) will be given for 20 mins.

In Sham NIBS arm, sham Noninvasive brain stimulation (NIBS) will be given for 20 mins.

Cervical Dystonia

Cathodal noninvasive brain stimulation will be given for 20 mins.

Active NIBS

The electrode placement will be same, but the electric current will be ramped down 5 seconds after the beginning of the stimulation

Sham NIBS

London Health Sciences Centre

A Trial of Non-invasive Stimulation in Cervical Dystonia

Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) will be assessed before and after stimulation. This scale is used to assess the severity of cervical dystonia and the success of its treatment. A total score of 0 to 35 can be achieved; this is made up of various sub scores- maximal excursion, duration of neck deviation, effect of sensory tricks, shoulder elevation/anterior displacement, range of motion, time to maintain in neutral position.

We will do network fragmentation by 5 mins of resting quantitative Electroencephalography (EEG), pre and post stimulation. All the frequency bands will be analyzed. The change of frequency bands leading to change in network fragmentation will plotted.

Angular deviations will be calculated by degree of freedom angular bias from calibrated neutral position. Amplitude measures will be reported as root mean square values.

Mandar Jog

Professor

Western University, Canada

BTX-A will be reconstituted as directed by the manufacturer. 2.5 mL of diluent (0.9% Saline) per 100 U vial will be used to reconstitute the solution while swirling. This creates a solution with a concentration of 4 U/0.1 mL. Patients will be seated and all usual precautions of sterility and skin preparation will be completed (i.e. alcohol wipes) Injections will be administered unilateral and/or bilaterally in accordance with the topography of the corresponding muscles (temporalis and masseter) into areas of maximal tenderness and pain. Plastic single use insulin syringes with 30 gauge needles will be used to inject 30 U intramuscularly into each masseter, divided evenly into 5 sites and 20 U will be injected into each temporalis, divided evenly over 5 sites. Injections will be completed by the principal investigator and supervisors who will be trained in botulinum toxin injections.

Temporo-Myofascial Disorder

Botulinum Toxin Type A

Treatment of Temporo-Myofascial Disorder of Muscular Origin Using Botulinum Toxin: A Prospective Study

Subjective pain scores will be assessed on a visual analog scale (VAS) where 0 is no pain and 10 is the worst facial or jaw pain they've ever experience. Subjective functional assessments will also be assessed with VAS where 0 means no limitation and 10 indicates severe limitation with scales for chewing, drinking, exercising, eating hard food, eating soft food, smiling or laughing, cleaning their teeth, yawning, swallowing and talking.

Range of motion will be assessed with a Boley gauge between the same upper and lower incisor each time

Pain to pressure will be ranked from 0 to 5, with 0 indicating no pain and 5 representing extreme debilitating pain. Addition of each score will give a composite score of the overall facial tenderness out of a maximal score of 24 (2 areas X 6 scores X bilaterally).

A point inferior to each ear lobule bilaterally will be marked as well as a point on the menton will be chosen and recorded. The distance unilaterally from one lobule to menton will be measured for left and right sides and a total distance will also be calculated to assess facial width.

torticollis/atrophie

Masseter Myofascial Pain Relief Following an Intra-muscular Injection With Botulinum Toxin Type A.

A Trial of Non-invasive Stimulation in Cervical Dystonia

Treatment of Temporo-Myofascial Disorder of Muscular Origin Using Botulinum Toxin: A Prospective Study

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