Botulinum Toxin a Injection of the Obturator Internus Muscle for Chronic Perineal Pain

Gajraj, Noor M.

doi:10.1016/j.jpain.2005.01.353

Cited by 36 publications

(35 citation statements)

References 60 publications

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“…Although this role has been considered by some, 26,41 there have been only 2 recent reports fully describing the management of this problem, 13 one of which is a single patient case report. 19 …”

Section: Syndrome Subcategoriesmentioning

confidence: 99%

Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery

Filler¹

2009

FOC

129

102

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Object To improve diagnostic accuracy and achieve high levels of treatment success in patients with pudendal nerve entrapment (PNE) syndromes, the author of this study applied advanced technology diagnostics in distinguishing the various syndrome types according to the different entrapment locations and evaluated new minimal access surgical techniques to treat each subtype. Methods Two hundred cases were prospectively evaluated using a standardized set of patient-completed functional and symptom assessments, a collection of new physical examination maneuvers, MR neurography, open MR image–guided injections, intraoperative neurophysiology, minimal access surgery, and formal outcome assessment with the Oswestry Disability Index, pain diagrams, and analog pain scales. Results Four primary types of PNE syndromes were identified based on the different locations of entrapment: Type I, entrapment at the exit of the greater sciatic notch in concert with piriformis muscle spasm; Type II, entrapment at the level of the ischial spine, sacrotuberous ligament, and lesser sciatic notch entrance; Type III, entrapment in association with obturator internus muscle spasm at the entrance of the Alcock canal; and Type IV, distal entrapment of terminal branches. The application of new, targeted minimal access surgical techniques led to sustained good to excellent outcomes (50–100% improvement in the pain score or functional score) in 87% of patients. Most of these patients obtained most of their improvement within 4 weeks of surgery, although some continued to experience progressive improvements up to 12 months after surgery. Conclusions The application of advanced diagnostics to categorize PNE syndrome origins into 4 major subtypes and the subsequent treatment of each subtype with a tailored strategy greatly improved therapeutic outcomes as compared with those reported when only a single treatment paradigm was applied to all patients.

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Section: Syndrome Subcategoriesmentioning

confidence: 99%

Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery

Filler¹

2009

FOC

129

102

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“…Podem ser efetivos tanto no diagnóstico como no tratamento de alguns casos de hiperalgesia pós-cirurgia pélvica ou trauma 27 . A dor crônica por espasmo de músculos do assoalho pélvico pode ser tratada também por bloqueio anestésico local, injeção de toxina botulí-nica, fi sioterapia ou eletro-estimulação [45][46][47][48][49] .…”

Section: Tratamentounclassified

Abordagem da dor pélvica crônica em mulheres

Nogueira¹,

Reis²,

Neto³

2006

Rev. Bras. Ginecol. Obstet.

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RESUMODor pélvica crônica é uma doença debilitante e de alta prevalência, com grande impacto na qualidade de vida e produtividade, além de custos signifi cantes para os serviços de saúde. O dilema no manejo da dor pélvica crônica continua a frustrar médicos confrontados com o problema, em parte porque sua fi siopatologia é pobremente compreendida. Conseqüentemente, seu tratamento é muitas vezes insatisfatório e limitado ao alívio temporário dos sintomas. Nesta revisão, nós discutimos uma abordagem ampliada da dor pélvica crônica. Salientamos que uma história clínica e exame físico adequados deveriam incluir atenção especial aos sistemas gastrintestinal, urinário, ginecológico, músculo-esquelético, neurológico, psicológico e endócrino. Dessa forma, uma abordagem multidisciplinar é recomendada. Adicionalmente, enfatizamos que, embora úteis, procedimentos cirúrgicos específi cos, tais como a laparoscopia, deveriam ser indicados somente para pacientes selecionadas, após excluir principalmente síndrome do intestino irritável e dor de origem miofascial. PALAVRAS-CHAVE: Dor pélvica; Síndrome do intestino irritável; Cistite intersticial; Endometriose; Laparoscopia; Prevalência ABSTRACTChronic pelvic pain is a debilitating and highly prevalent disease with a major impact on quality of life and work productivity, beyond signifi cant costs to health services. The dilemma of managing patients with chronic pelvic pain continues to frustrate physicians confronted with these complaints, in part because its pathophysiology is poorly understood. Consequently, its treatment is often unsatisfactory and limited to temporary symptom relief. In the present revision, we discuss the adequate management of chronic pelvic pain. We point out that a comprehensive medical history and physical examination should include special attention to gastrointestinal, urological, gynecological, muscle-skeletal, neurological, psychiatric, and endocrine systems. Thus, a multidisciplinary approach is recommended. Additionally, we emphasize that, although useful, specifi c surgical procedures, such as laparoscopy, should be indicated only to selected patients, mainly after excluding irritable bowel syndrome and pain of myofascial origin.

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“…Eine randomisiert kontrollierte Studie (Abbott et al, 2006), 6 open-label Studien (Brown et al, 2006;Christiansen et al, 2001;Gajraj, 2005;Jarvis et al, 2004;Maria et al, 2000;Pascual et al, 2005;Phelan et al, 2001;Tranqui et al, 2006;Zermann et al, 2000) sich gegenüber der konservativen Therapie als refraktär erwiesen hatten (Abbott et al, 2006;Brown et al, 2006).…”

Section: Funktionsstörungen Des Beckenbodensunclassified

Botulinumtoxin in der Urologie

Schulte-Baukloh

Knispel

2004

Urologe [A]

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Botulinum Toxin a Injection of the Obturator Internus Muscle for Chronic Perineal Pain

Cited by 36 publications

References 60 publications

Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery

Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery

Abordagem da dor pélvica crônica em mulheres

Botulinumtoxin in der Urologie

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