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Investigators studied the effect on patient pain of botulinum toxin injections to cutaneous leiomyomas. Eighteen patients who reported pain at least weekly from such lesions at a level of at least 4 on a 0–10-point scale were randomized to receive injections to the affected areas of botulinum toxin at 5 units/cm2 or equal volumes of placebo.
Pain was measured before and after ice provocation at 4 weeks after injection. Nominal, nonsignificant decreases in pain were reported on the visual analog pain scale in botulinum toxin recipients before ice provocation. No significant difference was observed regarding change in pain after ice provocation. Quality of life as assessed by the Dermatology Life Quality Index and its specific pain-related item was significantly improved in the toxin group (toxin: median, −1.00; range, −2.00 to 1.00; placebo: median, 0.00; range, −1.00 to 0.00; P=0.048).
Naik HB et al. Efficacy of intralesional botulinum toxin A for treatment of painful cutaneous leiomyomas: A randomized clinical trial. JAMA Dermatol 2015 Oct; 151:1096. (http://dx.doi.org/10.1001/jamadermatol.2015.1793)
Comment
Botulinum toxin may be of therapeutic utility in patients with symptomatic and painful leiomyomas. It is possible that the lack of between-group differences on the pain visual analog scale was due to the complex nature of leiomyoma-related discomfort, which may not be reducible to pain but may include other elements that are more difficult to describe and quantify.