Evaluating the effects of ice application on patient comfort before and after botulinum toxin type A injections

J Med Assoc Thai. 2010 Oct;93(10):1200-4.


Objective: To evaluate the efficacy of ice application in reducing pain during botulinum toxin type A injections.

Design: 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, group 1 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blepharospasm / drug therapy*
  • Botulinum Toxins, Type A / administration & dosage*
  • Facial Pain / prevention & control
  • Female
  • Hemifacial Spasm / drug therapy*
  • Humans
  • Ice*
  • Injections
  • 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