Botulinum Toxin for the Pain Management in Musculoskeletal and Temporomandibular Disorders

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 615

Special Issue Editors


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Guest Editor
Department of Health Sciences, University Magna Graecia di Catanzaro, 88100 Catanzaro, Italy
Interests: botulinum toxin; oral health; temporomandibular disorders; myofascial pain
Special Issues, Collections and Topics in MDPI journals

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Guest Editor

Special Issue Information

Dear Colleagues,

Orofacial and musculoskeletal pain represent a rapidly growing clinical and research challenge, affecting millions of patients and significantly limiting quality of life, functional capacity, and psychological well-being. Across rehabilitation medicine, pain medicine, dentistry, aesthetic medicine, and maxillofacial surgery, there is increasing interest in innovative, mechanism-based strategies capable of addressing the complex interplay between muscular hyperactivity, peripheral and central sensitization, and dysfunctional motor patterns. Among these strategies, botulinum toxin (BoNT) has emerged as a uniquely versatile therapeutic tool with expanding evidence supporting its role not only in neuromuscular modulation but also in peripheral and central pain modulation. Originally applied for focal dystonias and aesthetic indications, BoNT is now recognized for its capacity to target pathophysiological mechanisms underlying chronic myofascial pain, neuropathic conditions, and movement-related dysfunctions. This Special Issue aims to provide a comprehensive, interdisciplinary, and evidence-driven platform for both scientific researchers and clinically active physicians who conduct research in the field of pain management. It seeks to deepen understanding of the biological foundations, clinical applications, and emerging frontiers of botulinum toxin in the treatment of orofacial and musculoskeletal pain.

Key topics of interest of the Special Issue include the following:

  • Temporomandibular disorders, bruxism, and orofacial myofascial pain;
  • Chronic headaches, cervico-cranial pain, and postural dysfunction;
  • Focal spasticity and muscle overactivity within the rehabilitation setting;
  • The use of BoNT in aesthetic medicine when analgesic or functional effects are clinically relevant;
  • Peripheral neuropathic pain and neuralgias involving the cranial and cervical regions;
  • Chronic musculoskeletal pain syndromes of the spine, shoulder, and extremities;
  • Ultrasound-guided and anatomy-guided injection techniques to improve precision and safety;
  • Optimized dosing strategies, treatment algorithms, safety profiles, and long-term outcome data;
  • Translational research on the cellular, molecular, and neurophysiological mechanisms of BoNT-mediated analgesia.

This Special Issue, “Botulinum Toxin for the Pain Management in Musculoskeletal and Temporomandibular Disorders”, welcomes a broad range of contributions, including original research articles, clinical trials, translational studies, systematic reviews, narrative reviews, technical notes, and educational or methodological papers that support clinical decision-making. Submissions focusing on innovation—such as novel formulations, alternative injection techniques, multimodal approaches, and integration into rehabilitation pathways—are particularly encouraged. By gathering insights from multiple specialties and promoting dialogue between basic scientists and clinical researchers, this Special Issue seeks to enhance the understanding and clinical utility of botulinum toxin as a therapeutic option. Ultimately, it aims to support the development of more effective, personalized, and mechanism-oriented treatment paradigms for patients suffering from orofacial and musculoskeletal pain.

Dr. Martina Ferrillo
Dr. Alessandro de Sire
Guest Editors

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Keywords

  • botulinum toxin
  • pain management
  • musculoskeletal pain
  • headaches
  • muscle overactivity
  • analgesic
  • injection
  • neuropathic pain
  • temporomandibular disorders
  • bruxism

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Published Papers (1 paper)

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Research

14 pages, 2217 KB  
Article
Clinical Effectiveness of IncobotulinumtoxinA Using a Standardized Protocol in the Management of Myogenous Temporomandibular Disorders: A 12-Month Retrospective Study
by David Faustino Ângelo, Henrique José Cardoso, Marcella Sarkis, Kelly Santos, Francesco Maffia, David Sanz and Francisco Salvado
Toxins 2026, 18(5), 220; https://doi.org/10.3390/toxins18050220 - 7 May 2026
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Abstract
Background: Myogenous temporomandibular disorders (TMDs) are a common subtype of orofacial pain. Evidence regarding treatment with botulinum toxin type A (BoNT-A) remains heterogeneous, and its use is generally limited to refractory cases. This study evaluated 12-month clinical outcomes following an incobotulinumtoxinA protocol (the [...] Read more.
Background: Myogenous temporomandibular disorders (TMDs) are a common subtype of orofacial pain. Evidence regarding treatment with botulinum toxin type A (BoNT-A) remains heterogeneous, and its use is generally limited to refractory cases. This study evaluated 12-month clinical outcomes following an incobotulinumtoxinA protocol (the Ângelo Botulinum Toxin Protocol®) in adults with DC/TMD-confirmed myogenous TMD unresponsive to conservative therapy. Methods: This retrospective observational study reviewed records from 98 adults treated with incobotulinumtoxinA following the predefined injection protocol. All patients had failed ≥ 3 months of conservative management and completed ≥ 12 months of follow-up. Outcomes included myalgia severity (0–3), patient-reported orofacial pain intensity (VAS 0–10), and maximum mouth opening (MMO). Favorable outcome criteria required myalgia 0–1 or VAS ≤ 2 and MMO ≥ 35 mm. Results: Myalgia significantly decreased at 12 months (2.69 ± 0.64 to 0.43 ± 0.85; p < 0.001). Patient-reported orofacial pain intensity also improved (2.44 ± 2.54 to 0.37 ± 1.33; p < 0.001). MMO remained stable, indicating preserved mandibular mobility. Overall, 79.6% of patients met the predefined favorable outcome criteria. Reintervention was required in 12 patients; 7 received additional incobotulinumtoxinA injections, and 5 underwent TMJ arthrocentesis. No complications were observed. Conclusion: This protocol was associated with improvements in muscular pain and orofacial discomfort while preserving mandibular mobility. However, given the retrospective design and absence of a control group, these findings should be interpreted as hypothesis generating. Full article
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