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Botulinum injections for myofascial pelvic pain

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Abstract

Introduction and hypothesis

The aim of this study was to assess the impact of botulinum toxin injection in women with myofascial pelvic pain (MFPP) syndrome of the pelvic floor who had failed conservative treatment.

Methods

This was a retrospective descriptive observational study of 48 consecutive patients receiving botulinum toxin to the pelvic floor for MFPP syndrome in a tertiary teaching hospital over an 8-year period. Trigger points were identified, and botulinum toxin was injected into the pelvic floor at the trigger points in doses ranging from 50 to 200 units. The patient-reported global impression of improvement scale was used to evaluate the success at follow-up, and adverse effects were recorded.

Results

Forty-six women attended for follow-up at 3–6 months. Of these, 34 (74%) reported an improvement in their symptoms (slightly better, much better, very much better), 12 (26%) had no change, and no patients reported worsening of symptoms. One patient (2%) reported transient postoperative faecal incontinence, which resolved after 2 weeks. There appeared to be no difference in outcome between the doses.

Conclusions

Botulinum toxin injection into the pelvic floor of women with MFPP appears to be beneficial in those who have failed conservative treatment. Prospective studies, including dose-finding studies, are now required.

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References

  1. Dellis A, Papatsoris AG. Intravesical treatment of bladder pain syndrome/interstitial cystitis: from the conventional regimens to the novel botulinum toxin injections. Expert Opin Investig Drugs. 2014;23(6):751–7.

    Article  CAS  Google Scholar 

  2. Rapp DE, Turk KW, Bales GT, Cook SP. Botulinum toxin type a inhibits calcitonin gene-related peptide release from isolated rat bladder. J Urol. 2006;175(3 Pt 1):1138–42.

    Article  CAS  Google Scholar 

  3. Jhang JF, Jiang YH, Kuo HC. Potential therapeutic effect of intravesical botulinum toxin type a on bladder pain syndrome/interstitial cystitis. Int J Urol. 2014;21(Suppl 1):49–55.

    Article  CAS  Google Scholar 

  4. Weise D, Weise CM, Naumann M. Central effects of botulinum neurotoxin-evidence from human studies. Toxins (Basel). 2019;11(1):6.

    Article  Google Scholar 

  5. Bhide AA, Puccini F, Khullar V, Elneil S, Digesu GA. Botulinum neurotoxin type a injection of the pelvic floor muscle in pain due to spasticity: a review of the current literature. Int Urogynecol J. 2013;24(9):1429–34.

    Article  Google Scholar 

  6. Karp BI, Tandon H, Vigil D, Stratton P. Methodological approaches to botulinum toxin for the treatment of chronic pelvic pain, vaginismus, and vulvar pain disorders. Int Urogynecol J. 2019;30(7):1071–81.

    Article  Google Scholar 

  7. Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev. 2011;12:CD005493.

    Google Scholar 

  8. Pacik PT. Botox treatment for vaginismus. Plast Reconstr Surg. 2009;124(6):455e–6e.

    Article  CAS  Google Scholar 

  9. Petersen CD, Giraldi A, Lundvall L, Kristensen E. Botulinum toxin type A-a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study. J Sex Med. 2009;6(9):2523–37.

    Article  CAS  Google Scholar 

  10. Abbott J. Gynecological indications for the use of botulinum toxin in women with chronic pelvic pain. Toxicon. 2009;54(5):647–53.

    Article  CAS  Google Scholar 

  11. Meister M, Brubaker A, Sutcliffe S, Lowder J. Effectiveness of botulinum toxin injection to the pelvic floor for treatment of pelvic floor myofascial pain in women: a systematic review and meta-analysis. American Journal of Obstetrics and Gynaecology. 2019;220(3, S 754):75.

    Google Scholar 

  12. Pastore EA, Katzman WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs. 2012;41(5):680–91.

    Article  Google Scholar 

  13. Thibault-Gagnon S, Morin M. Active and passive components of pelvic floor muscle tone in women with provoked vestibulodynia: a perspective based on a review of the literature. J Sex Med. 2015;12(11):2178–89.

    Article  Google Scholar 

  14. Moldwin RM, Fariello JY. Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy. Curr Urol Rep. 2013;14(5):409–17.

    Article  Google Scholar 

  15. Tu FF, As-Sanie S, Steege JF. Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. J Reprod Med. 2006;51(3):185–9.

    PubMed  Google Scholar 

  16. Bendana EE, Belarmino JM, Dinh JH, et al. Efficacy of transvaginal biofeedback and electrical stimulation in women with urinary urgency and frequency and associated pelvic floor muscle spasm. Urol Nurs. 2009;29(3):171–6.

    PubMed  Google Scholar 

  17. Bassaly R, Tidwell N, Bertolino S, Hoyte L, Downes K, Hart S. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. Int Urogynecol J. 2011;22(4):413–8.

    Article  Google Scholar 

  18. Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE. Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology. 2010;138(4):1321–9.

    Article  Google Scholar 

  19. Gentilcore-Saulnier E, McLean L, Goldfinger C, Pukall CF, Chamberlain S. Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program. J Sex Med. 2010;7(2 Pt 2):1003–22.

    Article  Google Scholar 

  20. American Psychiatric Association. DSM −5; American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. 2013. Ref Type: Edited Book.

  21. Padoa A, Rosenbaum T. The Overactive Pelvic Floor. 2016.

  22. Nilges P, Essau C. Depression, anxiety and stress scales: DASS—A screening procedure not only for pain patients. Schmerz. 2015;29(6):649–57.

    Article  CAS  Google Scholar 

  23. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45–56.

    Article  Google Scholar 

  24. Cheshire WP, Abashian SW, Mann JD. Botulinum toxin in the treatment of myofascial pain syndrome. Pain. 1994;59(1):65–9.

    Article  Google Scholar 

  25. Graboski CL, Gray DS, Burnham RS. Botulinum toxin a versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: a randomised double blind crossover study. Pain. 2005;118(1–2):170–5.

    Article  CAS  Google Scholar 

  26. Pacik PT, Geletta S. Vaginismus treatment: clinical trials follow up 241 patients. Sex Med. 2017;5(2):e114–23.

    Article  Google Scholar 

  27. Adelowo A, Hacker MR, Shapiro A, Modest AM, Elkadry E. Botulinum toxin type a (BOTOX) for refractory myofascial pelvic pain. Female Pelvic Med Reconstr Surg. 2013;19(5):288–92.

    Article  Google Scholar 

  28. Halder GE, Scott L, Wyman A, et al. Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain. Investig Clin Urol. 2017;58(2):134–9.

    Article  Google Scholar 

  29. Nesbitt-Hawes EM, Dietz HP, Abbott JA. Four-dimensional ultrasound guidance for pelvic floor botulinum toxin-a injection in chronic pelvic pain: a novel technique. Ultrasound Obstet Gynecol. 2018;51(3):396–400.

    Article  CAS  Google Scholar 

  30. Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018;29(5):631–8.

    Article  Google Scholar 

  31. Yaraghi M, Ghazizadeh S, Mohammadi F, et al. Comparing the effectiveness of functional electrical stimulation via sexual cognitive/behavioral therapy of pelvic floor muscles versus local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus: a randomized clinical trial. Int Urogynecol J. 2019;30(11):1821–8.

    Article  Google Scholar 

  32. Yalcin I, Bump RC. Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol. 2003;189(1):98–101.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK

    Swati Jha

  2. Department of Urogynaecology, Birmingham Women’s & Children’s Hospital NHS Foundation Trust, Birmingham, B15 2TG, UK

    Philip Toozs-Hobson, Sabitra Gurung & Amallia Brair

  3. Department of Urogynaecology, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK

    Joanna C. Roper

  4. Department of Obstetrics and Gynaecology, Christchurch Women’s Hospital, Christchurch Central City, New Zealand

    Fiona Bach

Authors
  1. Swati Jha
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  2. Philip Toozs-Hobson
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  3. Joanna C. Roper
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  4. Sabitra Gurung
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  5. Amallia Brair
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  6. Fiona Bach
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Contributions

Manuscript write-up: SJ; PTH; SG; FB.

Data collection and abstract: PTH; JR; SG; FB; AB.

Data analysis: SJ; PTH.

Project conception: PTH.

Corresponding authors

Correspondence to Philip Toozs-Hobson or Sabitra Gurung.

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Jha, S., Toozs-Hobson, P., Roper, J.C. et al. Botulinum injections for myofascial pelvic pain. Int Urogynecol J 32, 1151–1156 (2021). https://doi.org/10.1007/s00192-020-04435-w

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  • DOI: https://doi.org/10.1007/s00192-020-04435-w

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