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1- Department of Surgery, Clinical Research Development Unit (CRDU), 5azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
2- Department of Surgery, Golestan University of Medical Sciences, Gorgan, Iran , ali1000alishah@gmail.com
Abstract:   (174 Views)
Background: Botulinum toxin type A (BoNT-A) is widely used for cosmetic wrinkle reduction, but injection-related pain varies among patients. Given that factors such as sex, BMI, handedness, and prior injection experience may influence pain perception, this study aimed to investigate the asymmetry of pain perception in botulinum toxin injection.
Methods: This cross-sectional study was conducted in the surgical department of 5 Azar Hospital and a private clinic in Gorgan, Iran. A total of 84 eligible subjects (68 females and 16 males) receiving botulinum toxin type A injection in the forehead were enrolled. Pain severity was assessed five minutes post-injection using the Visual Analogue Scale (VAS, 0–10). Each participant provided a separate VAS score for the left and right sides of the forehead, resulting in paired measurements for analysis. Statistical analyses, including paired t-tests, Pearson correlation, and linear regression model, were employed to examine the effects of variables such as gender, age, BMI, and handedness. A p-value of less than 0.05 was considered statistically significant.
Results: This study included a total of 84 participants, predominantly female (81%). A paired analysis revealed that pain was generally higher on the left side, with females reporting significantly greater discomfort than males (P = 0.037). Prior injection experience was associated with reduced pain asymmetry (R = –0.227, P = 0.038). Multiple regression analysis identified sex (P = 0.025, β = 0.218) and BMI (P = 0.012, β = 0.293) as significant predictors of pain difference.
Conclusion: Adopting individualized injection strategies that consider these patient-specific factors (such as sex and BMI) is crucial for enhancing comfort and satisfaction during the procedure.
     
Type of Article: Original article | Subject: General medicine
Received: 2025/04/12 | Accepted: 2025/06/25

References
1. Rho N-K, Han K-H, Kim H-S. An update on the cosmetic use of botulinum toxin: the pattern of practice among Korean dermatologists. Toxins. 2022;14(5):329. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Sunil SM, Babu BG, Deepthi S, Veerabhadrappa AC, Vadavadagi SV, Punde P. Botulinum toxin for the treatment of hyperfunctional lines of the forehead. J Int Soc Prev Community Dent. 2015;5(4):276-82. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Zargaran D, Zoller F, Zargaran A, Rahman E, Woollard A, Weyrich T, et al. Complications of cosmetic botulinum toxin A injections to the upper face: a systematic review and meta-analysis. Aesthet Surg J. 2022;42(5):NP327-NP36. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Fouché JJ, Van Loghem JAJ, Thuis J, De Heer LM, van Oijen MG. Left/right pain asymmetry with injectable cosmetic treatments for the face. Aesthet Surg J. 2017;37(6):708-14. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Pud D, Golan Y, Pesta R. Hand dominancy-a feature affecting sensitivity to pain. Neurosci Lett. 2009;467(3):237-40. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Symonds LL, Gordon NS, Bixby JC, Mande MM. Right-lateralized pain processing in the human cortex: an FMRI study. J Neurophysiol. 2006;95(6):3823-30. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Wee SY, Park ES. Immunogenicity of botulinum toxin. Arch Plast Surg. 2022;49(1):12-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Nigam PK, Nigam A. Botulinum toxin. Indian journal of dermatology. 2010;55(1):8-14. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Sorensen EP, Urman C. Cosmetic complications: rare and serious events following botulinum toxin and soft tissue filler administration. J Drugs Dermatol. 2015;14(5):486-91. [View at Publisher] [PMID] [Google Scholar]
10. Ayoub N. Botulinum toxin therapy: a comprehensive review on clinical and pharmacological insights. J Clin Med. 2025;14(6):2021. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Fonfria E, Maignel J, Lezmi S, Martin V, Splevins A, Shubber S, et al. The expanding therapeutic utility of botulinum neurotoxins. Toxins. 2018;10(5):208. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Molaei A, Hemmati M, Izadi S, Paknazar F, Shakeri S, Hemmati H. Response to treatment with Botulinum toxin-A in patients with Refractory Chronic Migraine. Iran South Med J. 2024;27(1):1-12. [View at Publisher] [DOI] [Google Scholar]
13. Aoki KR. Evidence for antinociceptive activity of botulinum toxin type A in pain management. Headache. 2013;43(1):9-15. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Dima L, Bălan A, Moga MA, Dinu CG, Dimienescu OG, Varga I, et al. Botulinum toxin a valuable prophylactic agent for migraines and a possible future option for the prevention of hormonal variations-triggered migraines. Toxins. 2019;11(8):465. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Turner-Stokes L, Buchwald K, Ashford SA, Fheodoroff K, Jacinto J, Narayanan A, et al. Pain reduction with repeated injections of botulinum toxin A in upper limb spasticity: a longitudinal analysis from the ULIS-III study. Toxins. 2025;17(3):117. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Atraszkiewicz D. The processes underlying chronic migraine pathophysiology and its treatment with botulinum toxin type A. Neurol Clin Neurosci. 2021;9(6):421-9. [View at Publisher] [DOI] [Google Scholar]
17. Bravo BSF, de Melo Carvalho R, Gallo BF, Bravo LG. A retrospective study supporting the importance of individualizing the dose of botulinum toxin according to the age. J Cutan Aesthet Surg. 2021;14(1):88-92. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. Santana L, Liu C. Experience of botulinum toxin A injections for chronic migraine headaches in a pediatric chronic pain clinic. J Pediatr Pharmacol Ther. 2021;26(2):151-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Kahn A, Bertin H, Corre P, Praud M, Paré A, Kün-Darbois J-D. Assessing the effectiveness of botulinum toxin injections into masticatory muscles in the treatment of temporomandibular disorders. J Oral Med Oral Sug. 2018;24(3):107-11. [View at Publisher] [DOI] [Google Scholar]
20. Wu-Fienberg Y, Ansari H, Zardouz S, Narouze S, Blaha T, Swanson M, et al. Anatomical look into onabotulinumtoxinA injection for chronic migraine headache. Reg Anesth Pain Med. 2018;43(8):869-74. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Dermitzakis EV, Vikelis M, Vlachos GS, Argyriou AA. Prospective comparison of longer needle lengths to assess the risk of onabotulinumtoxinA-associated neck pain in patients with chronic migraine. Toxins. 2022;14(7):434. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Lugo M, Istúriz G, Lara C, García N, Eblen-Zajjur A. Sensory lateralization in pain subjective perception for noxious heat stimulus. Somatosens Mot Res. 2002;19(3):207-12. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Alam M, Geisler A, Sadhwani D, Goyal A, Poon E, Nodzenski M, et al. Effect of needle size on pain perception in patients treated with botulinum toxin type A injections: a randomized clinical trial. JAMA Dermatol. 2015;151(11):1194-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. Kämmerer TA, Bertlich R, Hartmann D, Jakob M, Weiss BG, Bertlich I, et al. Subjective discomfort during botulinumtoxin injections dependent on injection site and needle size: A comparison between 30g, 33g and 34g needles. Aesthetic Plast Surg. 2024;48(13):2528-35. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Maytharakcheep S, Phokaewvarangkul O, Bhidayasiri R. Does needle size matter? Effects of micro-hypodermic needle injections of botulinum toxin type A in patients with hemifacial spasm. Parkinsonism Relat Disord. 2024;118:105950. [View at Publisher] [DOI] [PMID] [Google Scholar]
26. de Abreu Venancio R, Guedes Pereira Alencar F, Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009;27(1):46-53. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Hablas SA, Nada DW, Alashkar DS, Elsharkawy AA. The effect of botulinum toxin type A injection in decreasing intratunnel tendon tension in carpal tunnel syndrome: a randomized controlled trial for efficacy and safety. Egypt. Rheumatol. Rehabil. 2019;46(4):299-303. [View at Publisher] [DOI] [Google Scholar]
28. Meretsky CR, Umali JP, Schiuma AT. A systematic review and comparative analysis of botox treatment in aesthetic and therapeutic applications: advantages, disadvantages, and patient outcomes. Cureus. 2024;16(8):e67961. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. Borba A, Matayoshi S, Rodrigues M. Avoiding complications on the upper face treatment with botulinum toxin: a practical guide. Aesthetic plastic surgery. 2022;46(1):385-94. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Kaplan JB. Consideration of muscle depth for botulinum toxin injections: a three-dimensional approach. Plast Surg Nurs. 2017;37(1):32-8. [View at Publisher] [DOI] [PMID] [Google Scholar]

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