Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain

Abstract

PurposeTo report the effects of combined onabotulinumtoxinA (Botox) injections and myofascial release physical therapy on myofascial pelvic pain (MFPP) by comparing pre- and posttreatment average pelvic pain scores, trigger points, and patient self-reported pelvic pain. Secondary outcomes were to examine posttreatment complications and determine demographic differences between patients with/without an improvement in pain.Materials and MethodsThis was an Institutional Review Board approved retrospective case series on women over 18 years with MFPP who received Botox and physical therapy between July 2006 and November 2014. Presence of trigger points and pelvic pain scores were determined by digital palpation of the iliococcygeus, puborectalis, obturator internus, and rectus muscles. Average pelvic pain scores (0–10) reflected an average of the scores obtained from palpation of each muscle. Self-reported improvement in pain was recorded as yes/no.ResultsFifty women met the inclusion/exclusion criteria. Posttreatment, patients had lower average pelvic pain scores (3.7±4.0 vs. 6.4±1.8, p=0.005), and fewer trigger points (44% vs. 100%, p<0.001). Fifty-eight percent of patients (95% confidence interval, 44–72) noted an improvement in self-reported pain. Patients most likely to report no improvement in pain had chronic bowel disorders, while those most likely to report an improvement in pain had a history of past incontinence sling (p=0.03). Posttreatment complications included: constipation (8%), worsening urinary retention (2%), and urinary tract infection (4%).ConclusionsBotox combined with soft tissue myofascial release physical therapy under anesthesia can be effective in treating women with chronic pelvic pain secondary to MFPP.

Botulinum toxin injection for chronic pelvic pain: A systematic review

“…Information Tables S1 and S2. Definitions of CPP varied among the studies but they could be grouped into two main categories: myofascial hypertonic disorders (three RCTs 11,27,28 and 10 observational studies 19,[29][30][31][32][33][34][35][36][37], and vulvodynia (two RCTs 38,39 and two observational studies 40,41 ). Given the heterogeneity in case definitions, interventions, metrics, designs, settings and outcome measures, the results from the RCTs could not be pooled into a meta-analysis.…”

“…11,34 Data had been collected prospectively in 14 studies, 11,19,[27][28][29][30][31][34][35][36][37][38][39][40] and retrospectively in three studies. 32,33,41 The number of women included in the different studies ranged from 12 36 to 241. 19 Age varied across our studies, with most studies involving women with a mean age of 25-35.1 years of age, 30,31 but three studies involved older women (median 43 27 and 55.0, 32 mean 44.5 33 ).…”

“…19,38 Seven studies had pre-or co-injection use of local anesthetics, in the forms of topical lidocaine gel, 27,35,36 topical lidocaine and prilocaine cream, 39,40 injected lidocaine or bupivacaine. 31,33 One study used general anesthesia 33 and five studies used conscious sedation during the injections. 19,28,29,35,36 Five studies included physiotherapy as part of the intervention.…”

“…19,28,29,35,36 Five studies included physiotherapy as part of the intervention. 19,27,33,34,40 The follow-up durations ranged from 12 weeks to 12 months post-injection in the RCTs, 27,39 and from 2 weeks to 24 months 30,37 post-injection in the observational studies. 30,33,37 All except one study included in-person visits for follow-ups.…”

Pelvic pain rehabilitation

“…In addition, a combination of botulinum toxin and physiotherapy for the management of pelvic myofascial pain is effective and patient selection is critical. [48] The effectiveness of therapeutic nerve blocks performed with the guidance of USG and CT in CPP treatment has been shown in several studies. [49] Nerve blocks are well-defined for acute pain; in addition, it is an active research field yielding positive results in recent studies.…”