Botulinum toxin type A (BOTOX) for refractory myofascial pelvic pain

Female Pelvic Med Reconstr Surg. Sep-Oct 2013;19(5):288-92. doi: 10.1097/SPV.0b013e3182989fd8.

Abstract

Objective: To assess intralevator botulinum toxin type A (Botox) injections for refractory myofascial pelvic pain with short tight pelvic floor.

Methods: Retrospective cohort study of all women with intralevator Botox injection (100-300 Units) from 2005 through 2010 for refractory myofascial pelvic pain. Primary outcomes were self-reported pain on palpation and symptom improvement. Secondary outcomes included postinjection complications and a second injection. Pain was assessed during digital palpation of the pelvic floor muscles using a scale of 0 to 10, with 10 being the worst possible pain. Follow-up occurred at less than 6 weeks after injection and again at 6 weeks or more. Data are presented as median (interquartile range) or proportion.

Results: Thirty-one patients met eligibility criteria; 2 patients were lostto follow-up and excluded. The median age was 55.0 years (38.0-62.0 years). Before Botox injection, the median pain score was 9.5 (8.0-10.0). Twenty-nine patients (93.5%) returned for the first follow-up visit; 79.3% reported improvement in pain, whereas 20.7% reported no improvement. The median pain with levator palpation was significantly lower than before injection (P<0.0001). Eighteen women (58.0%) had a second follow-up visit with a median pain score that remained lower than before injection (P<0.0001). Fifteen (51.7%) women elected to have a second Botox injection; the median time to the second injection was 4.0 months (3.0-7.0 months). Three (10.3%) women developed de novo urinary retention, 2 patients (6.9%) reported fecal incontinence, and 3 patients (10.3%) reported constipation and/or rectal pain; all adverse effects resolved spontaneously.

Conclusions: Intralevator injection of Botox demonstrates effectiveness in women with refractory myofascial pelvic pain with few self-limiting adverse effects.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / adverse effects
  • Botulinum Toxins, Type A / therapeutic use*
  • Constipation / chemically induced
  • Fecal Incontinence / chemically induced
  • Female
  • Humans
  • Injections, Intramuscular
  • Middle Aged
  • Myofascial Pain Syndromes / drug therapy*
  • Neuromuscular Agents / adverse effects
  • Neuromuscular Agents / therapeutic use*
  • Pain Measurement
  • Pain, Intractable / drug therapy*
  • Pelvic Pain / drug therapy*
  • Retrospective Studies
  • Urinary Retention / chemically induced

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A