• Sharon Fung, Chetan P Phadke, Alice Kam, Farooq Ismail, and Chris Boulias.
• Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada.
• Arch Phys Med Rehabil. 2012 Sep 1; 93 (9): 1643-7.

ObjectiveTo compare pain perception using 3 anesthetics (eutectic mixture of local anesthetics [EMLA], vapocoolant spray, and ice) compared with a control (no anesthetic) during botulinum toxin type A (BTX-A) injections for lower limb spasticity.DesignA placebo-controlled, single-blinded study where each study patient served as their own control.SettingSpasticity clinic.ParticipantsSubjects (N=30) with ankle spasticity who visited the clinic for BTX-A injections in the gastrocnemius muscle were consecutively sampled.InterventionThe gastrocnemius muscle was divided into 4 quadrants and 1 of the 3 different anesthetic agents was applied to each quadrant with 1 quadrant using no anesthetic, control.Main Outcome MeasuresNumerical Rating Scale (NRS) and the Wong-Baker FACES scale.ResultsPain perception using the NRS and FACES scale was significantly lower using ice and EMLA compared with control and spray conditions (P<.05). Pain perception using EMLA and ice was similar. These results indicate that patients experience minimal to moderate pain during BTX-A injections.ConclusionsPain relief offered by EMLA and ice was comparable, suggesting that ice is a more convenient option because of brief application time (compared with EMLA). Spray may have made the patients more sensitive to pain and alternative approaches for using vapocoolant should be considered.Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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