Evaluating the effects of ice application on the pain felt during botulinum toxin type-a injections: a prospective, randomized, single-blind controlled trial

Ann Plast Surg. 2004 Dec;53(6):543-6. doi: 10.1097/01.sap.0000139563.51598.75.


The pain felt during botulinum toxin type-A injections and the troubled and distressed treatment it induces is common and well known for the patient and the doctor applying the treatment. This problem is further intensified on the patients who have needle phobia. The effect of ice application on the treatment zone before botulinum toxin type-A treatment on the pain felt during injections is investigated. Totally, 24 patients who underwent botulinum toxin type-A treatment in upper face region for esthetic purposes are included in the study. Ice was applied 5 minutes before the injections on the right lateral orbital zones (crow's feet area) of the patients, whereas on their left sides, toxin was injected without applying any ice. All the drugs were diluted by normal saline; 5 U of active botulinum toxin type-A was used in each diziem (0.1 mL). Total injection number was determined both in right and left areas as 8. Visual analog scale (VAS) was used for pain intensity and evaluation. On the side where ice was applied, the treatment was completed in 1 session and lasted shorter when compared with that of the control side. However, the average VAS values defining the pain that the patients felt in their right and left sides were found as 1.1 and 5.9, respectively. The clinical findings obtained indicated that pain is significantly reduced on the side where ice is applied. The statistical significance of the test results were evaluated by Student's t test, and the difference between VAS values was found statistically significant (P = 0.000).

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / administration & dosage*
  • Facial Muscles / drug effects
  • Facial Pain / chemically induced*
  • Facial Pain / prevention & control*
  • Female
  • Humans
  • Ice*
  • Male
  • Middle Aged
  • Neuromuscular Agents / administration & dosage*
  • Pain Measurement
  • Prospective Studies
  • Severity of Illness Index
  • Single-Blind Method
  • Time Factors
  • Treatment Outcome


  • Ice
  • Neuromuscular Agents
  • Botulinum Toxins, Type A