Botulinum Toxin for First Bite Syndrome: A Symptom-Guided "Follow-The-Pain" Injection Strategy

Area of Science:

• Neurology
• Otolaryngology
• Pain Management

Background:

• First Bite Syndrome (FBS) is a rare condition causing severe pain upon the first bite.
• Standard treatments for FBS often provide incomplete relief for some patients.

Purpose of the Study:

• To evaluate the efficacy of botulinum toxin type A (BoNT-A) for managing FBS.
• To assess a symptom-guided "Follow-the-Pain" (FTP) injection strategy in patients with suboptimal response to standard FBS treatment.

Main Methods:

• Ultrasound-guided intraparotid injection of BoNT-A was administered to patients with postoperative FBS.
• Patients with partial or poor response received additional targeted BoNT-A injections based on reported maximal pain sites (FTP protocol).
• Pain intensity was measured using a Visual Analog Scale (VAS), and outcomes were tracked via patient diaries.

Main Results:

• Five patients (mean age 41) with FBS were included in the study.
• Standard treatment provided significant improvement in one patient, partial benefit in three, and no response in one.
• The four patients with persistent symptoms who underwent the FTP protocol experienced additional pain reduction, with symptom recurrence necessitating retreatment every 5-6 months.

Conclusions:

• Botulinum toxin type A (BoNT-A) demonstrates effectiveness in treating First Bite Syndrome (FBS).
• A symptom-guided "Follow-the-Pain" (FTP) strategy can offer supplementary benefits for patients with persistent or partially controlled FBS symptoms within a structured management plan.