The efficacy of botulinum toxin a injections in pelvic floor muscles in chronic pelvic pain patients: a systematic review and meta-analysis

Abstract

Introduction and hypothesis Chronic pelvic pain (CPP) is a common multifactorial condition affecting 6 to 27% of women aged 18–50 years worldwide. This study was conducted to review and meta-analyse the current literature on the reduction of chronic pelvic pain after botulinum toxin A (BTA) injection. Method In July 2021 we performed a systematic search in PubMed and EMBASE to assess the benefits of BTA injection in pelvic floor muscles in women with chronic pelvic pain. Primary outcome was reduction in visual analogue scale (VAS) after treatment. Secondary outcomes evaluated were: reduction of dyspareunia, pelvic floor resting pressure and quality of life. Identified reports were assessed on quality of reporting and risk of bias. Standardized mean difference (SMD) was used to combine and analyse outcomes of the included studies. Results Eight studies with 289 participants were considered eligible to be included in this systematic review and meta-analysis. After recalculating SMD into VAS scores (0–100), long-term follow-up (24–26 weeks) showed a significant 15-point improvement in VAS scores (95% CI: 8.8–21.5) for non-menstrual pelvic pain and a 13-point improvement (95% CI: 2.1–24.0) for dyspareunia. BTA injection had a significant effect on pelvic floor resting pressure and quality of life. Conclusion There is limited scientific evidence on the effectiveness of BTA injections in pelvic floor muscles in women with chronic pelvic pain. The available studies show that BTA injections significantly reduce pain levels and improve quality of life at 6 months follow-up. Prospero ID CRD42018105204.

Sexual Dysfunction and Dyspareunia in the Setting of the Genitourinary Syndrome of Menopause

“…A recent systematic review and meta-analysis evaluating the use of pelvic floor Botox in women with chronic pelvic pain showed that a significant improvement in both nonmenstrual pelvic pain and dyspareunia could be achieved in tandem with improvements in pelvic floor resting pressure and quality of life. 69 Of note, studies investigating Botox for pelvic floor relaxation are variable in doses used (commonly ranging from 20 to 500 units), use of electromyography or ultrasound guidance, number of sessions, and muscles injected (most commonly the levator ani complex) so patients should be counseled that titration and reinjection may be required to achieve relief. 70 Overall, reported serious adverse event rates are low but are more common with higher doses of Botox including urinary and fecal incontinence, urinary retention, and constipation.…”

“…There is limited evidence on the effectiveness of intramuscular and intravaginal pharmacologic interventions for GSM and dyspareunia due to pelvic floor hypertonicity, although emerging therapies are being reported that may serve as viable adjuncts, especially in refractory cases. A recent systematic review and meta-analysis evaluating the use of pelvic floor Botox in women with chronic pelvic pain showed that a significant improvement in both nonmenstrual pelvic pain and dyspareunia could be achieved in tandem with improvements in pelvic floor resting pressure and quality of life 69 . Of note, studies investigating Botox for pelvic floor relaxation are variable in doses used (commonly ranging from 20 to 500 units), use of electromyography or ultrasound guidance, number of sessions, and muscles injected (most commonly the levator ani complex) so patients should be counseled that titration and reinjection may be required to achieve relief 70 .…”

Wide range applications of botulinum toxin in medicine - literature review

“…Wykazano, że iniekcje z toksyną botulinową u kobiet z tą dolegliwością miało istotny wpływ na złagodzenie bólu oraz poprawę jakości życia. [31]…”

Botulinum Toxin for the Management of Pelvic Floor Tension Myalgia and Persistent Pelvic Pain

“…Recent systematic reviews are limited because they are incomplete, pool nonrandomized with randomized data for meta-analyses, and include unpublished data, 25 potentially overestimating treatment effect. 25,26 This study aims to systematically identify and assess the quality of data examining the use of botulinum toxin for management of pelvic floor tension myalgia and persistent pelvic pain and to provide analyses of pooled randomized data.…”