Reduction of pain and anxiety prior to botulinum toxin injections with a new topical anesthetic method.

PURPOSE: To evaluate the safety and efficacy of vapocoolants (topical skin refrigerants) to induce skin anesthesia and relieve patient anxiety and pain prior to cosmetic botulinum injections.

METHODS: A paired (split-face) design was used in 52 patients where patient side (left vs. right) was randomized to receive either vapocoolant spray or no treatment control to test the study hypothesis of better anesthetic efficacy of vapocoolant spray versus no treatment control. A pain and anxiety questionnaire was administered before, during, and after the injections.

RESULTS: A considerable percentage of patients either expected pain (35% of naïve patients expected moderate pain) or had experienced pain from their prior treatment (35% had experienced moderate pain). Among naïve patients, 15% had moderate or severe anxiety and among experienced patients, 31% had moderate anxiety. Pain was a factor in delaying the scheduling of cosmetic botulinum toxin treatments in 19% of naïve patients and 31% of experienced patients. Pain reported from actual injections was higher than what was anticipated prior to treatment. There was a significant reduction in pain at injection sites treated with vapocoolant (p < 0.001, paired t test). Overall, 67% of all patients reported that the vapocoolant method had less pain than no anesthesia and 54% preferred vapocoolant for their next treatment. Overall, 6% of all patients would schedule their next botulinum toxin treatment sooner if vapocoolant were available.

CONCLUSIONS: Vapocoolants represent a safe and effective means to reduce patient discomfort and anxiety before and during botulinum toxin type A treatments for glabellar area indications.