, 2010). Myofascal pain syndrome (MFPS) is characterized by

the presence of trigger points, palpable muscle abnormality and referred pain distal to the trigger point. Most of its treatments are aimed to reduce the pain in trigger points and to reduce the muscle spasm. The traditional treatments of MFPS consist of physical therapy, oral medications and trigger point injections (Annaswamy et al., 2011). In 2010, Delaram DAPT purchase et al. reported two cases where proximal myofascial pain in complex regional pain syndrome (CPRS) was treated with an injection of 20 units of BoNT/A in each trigger point. The therapeutic effect was reported to be satisfactory. However, there are limited number of reports on myofascial pain syndrome in the literature. Therefore, this area needs more continued research and exploration (Safarpour and Jabbari, 2010). Trigeminal neuralgia (TN) is a severe chronic pain syndrome characterized by an excruciating, brief electric shocklike paroxysmal pain in one or more divisions of the trigeminal

nerve. It can occur either spontaneously or upon gentle tactile stimulation of a trigger zone on the face or in the oral cavity (Fields, 1996, Cheshire, 2007 and Devor et al., 2002). There are two major methods of treatment for TN; selleck pharmacotherapy and neurosurgical procedures. Pharmacotherapy is the routine way of treatment and includes the use of antiepileptic drugs like carbamazepine with the secondary drug choice to be baclofen, lamotrigine, oxcabazepine, phenytoin, gabapentin or sodium valproate (Merrison and Fuller, 2003). This is generally safer and more suitable for medically compromised patients who cannot undergo surgery. Rebamipide For those patients who do not respond well to medical management, surgery is the only option. In the past few years, several reports on the successful use of BoNT/A in patients with TN seem to give us a new way to subside this kind of refractory chronic pain. In 2005, Piovesan et al. reported their success in nearly complete pain relief in all

of their 13 patients with subdermal injections of BoNT/A at a mean dose of 3.22 units/cm2 directly into the affected facial regions for 10 days. The patients were followed up for 60 days (Piovesan et al., 2005). Allam et al. reported a longer duration of pain relief for 90 days in their single patient (Allam et al., 2005). In 2009, Wei et al. achieved a longer pain-free duration of five months. However, the doses used in the study were several times higher (100 units) than that of the former studies. The injection was performed subcutaneously into the right external nasal trigger zone (60 units) and to the right mental nerve region (40 units). The pain recurred five months later and the site was again injected with 100 units of BoNT/A. In their study, the repeated injections were useful in promoting a continuous pain-free state. However, the patient lost the nasolabial fold on the right side of the face (Ngeow and Nair, 2010).