Cooling by frozen gel pack as pain relief during treatment of axillary hyperhidrosis with botulinum toxin a injections.

Botulinum toxin A injection is a well-described efficacious treatment for axillary hyperhidrosis. Although considered a safe treatment, many patients experience pain during injections. The purpose of the present study was to examine whether cooling by frozen gel packs applied in the axilla for 5 min before treatment could reduce pain. Thirty-six patients with axillary hyperhidrosis were included in this randomized, open-label prospective study, in which patients were their own controls. Pain was assessed before, during (four times), and immediately after treatment, using a numeric rating scale. The patients experienced statistically significant pain reduction, of 14-19%, in areas cooled by frozen gel pack (p<0.01). However, the clinical relevance of this relatively small pain reduction is questionable.