Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles

Jarvis, Sherin K.; Abbott, Jason; Lenart, Meegan; Steensma, Anneke B.; Vancaillie, Thierry G.

doi:10.1111/j.1479-828x.2004.00163.x

Cited by 147 publications

(146 citation statements)

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“…Studies utilizing transvaginal injection of trigger points are limited but predominantly include the attempts at relief of levator ani muscle spasm using botulinum Neurourology and Urodynamics DOI 10.1002/nau toxin A, utilizing the theory that paralysis of a spastic levator muscle will relieve pain [Romito et al, 2004;Fitzgerald et al, 2005;Thomson et al, 2005]. A study by Jarvis et al [2004] showed signi¢cant improvement on VAS in 12 women with the use of botulinum toxin A using three di¡erent dilutions [Thomson et al, 2005]. Other treatments with pelvic £oor muscle rehabilitation or electrogalvanic stimulation have also shown promising results.…”

Section: Discussionmentioning

confidence: 99%

Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain

Langford

Nagy

Ghoniem

2007

Neurourology and Urodynamics

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Aims: We conducted this study to examine the role of trigger point injections in females with chronic pelvic pain (CPP) of at least 6 months duration and speci¢c levator ani trigger points. Methods: This prospective study included 18 consecutive female patients with CPP and speci¢c palpable levator ani trigger points. Pain was evaluated before and after trigger point injection on a Visual Analog Scale (VAS). Patient global satisfaction (PGS) and cure rates (PGC) were also measured by aVAS on a scale of 0^100%. The trigger points were identi¢ed manually by intravaginal palpation of the levator ani bilaterally. A mixture of 10 cc of 0.25% bupivacaine, 10 cc of 2% lidocaine and 1 cc (40 mg) of triamcinolone was used for injection of 5 cc per trigger point. A 5.5 00 Iowa trumpet pudendal needle guide was used for injection. All but one injection were performed in the o⁄ce setting without sedation. Pelvic £oor muscle exercises were taught for use after injection. Success was de¢ned as a decrease in pain as measured by a VAS of 50% or more, as well as PGS and PGC scores of 60% or greater. There was a mean follow up of 3 months after trigger point injection.Results: Thirteen of 18 women improved with the ¢rst trigger point injection resulting in a comprehensive success rate of 72%. Six (33%) of 18 women were completely pain free. Conclusion: In the management of CPP, a non-surgical o⁄ce-based therapy such as trigger point injections can be e¡ective in selected patients. Neurourol. Urodynam. 26: 59^62, 2007. ß 2006

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Section: Discussionmentioning

confidence: 99%

Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain

Langford

Nagy

Ghoniem

2007

Neurourology and Urodynamics

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“…Sherin et al en un estudio piloto tratan con inyecciones de bó tox a 12 mujeres con dolor pé lvico cró nico asociado con espasmo del elevador del ano. Obtienen resultados esperanzadores al conseguir alivio del dolor y disminuir el hipertonicidad 48,49 . Otros autores solo recomiendan la toxina cuando han fracasado otras medidas terapéuticas más sencillas como la aguja seca 50 .…”

Section: Infiltraciones Con Toxina Botulínicaunclassified

Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente

Itza¹,

Zarza²,

Serra³

et al. 2010

Actas Urol Esp

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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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Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles

Abstract: There is evidence from the present pilot study suggesting that women with pelvic floor muscles hypertonicity and pelvic pain may respond to BOTOX injections into the pelvic floor muscles. Further research into this novel treatment of chronic pelvic pain is strongly recommended.

Cited by 147 publications

References 13 publications

Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain

Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain

Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente

Abordagem da dor pélvica crônica em mulheres

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