Investig Clin Urol.  2017 Mar;58(2):134-139. 10.4111/icu.2017.58.2.134.

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

• Halder GE
• Scott L
• Wyman A
• Mora N
• Miladinovic B
• Bassaly R
• Hoyte L

• KMID: 2368479
• DOI: http://doi.org/10.4111/icu.2017.58.2.134

Abstract

PURPOSE
To 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 METHODS
This 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.
RESULTS
Fifty 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%).
CONCLUSIONS
Botox combined with soft tissue myofascial release physical therapy under anesthesia can be effective in treating women with chronic pelvic pain secondary to MFPP.

Keyword

Botox; Myofascial pain; Pelvic pain; Therapy

MeSH Terms

Anesthesia
Constipation
Ethics Committees, Research
Female
Humans
Muscles
Palpation
Pelvic Pain*
Retrospective Studies
Trigger Points
Urinary Retention
Urinary Tract Infections

Reference

1. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996; 87:321–327.

2. Borg-Stein J, Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil. 2002; 83:3 Suppl 1. S40–S47. S48–S49.

3. Srinivasan AK, Kaye JD, Moldwin R. Myofascial dysfunction associated with chronic pelvic floor pain: management strategies. Curr Pain Headache Rep. 2007; 11:359–364.

4. Jarvis SK, Abbott JA, Lenart MB, Steensma A, Vancaillie TG. Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles. Aust N Z J Obstet Gynaecol. 2004; 44:46–50.

5. Abbott JA, Jarvis SK, Lyons SD, Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol. 2006; 108:915–923.

6. Stata Corporation. Stata release 13: data analysis and statistical software. College Station (TX): StataCorp LP;2013.

7. Mense S, Simons DG, Russell IJ. Muscle pain: understanding its nature, diagnosis, and treatment. Philadelphia (PA): Lippincott Williams & Wilkins;2001.

8. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol (1985). 2005; 99:1977–1984.

9. Kuan TS. Current studies on myofascial pain syndrome. Curr Pain Headache Rep. 2009; 13:365–369.

10. Lang AM. Botulinum toxin type A therapy in chronic pain disorders. Arch Phys Med Rehabil. 2003; 84:3 Suppl 1. S69–S73.

11. Raj PP. Botulinum toxin therapy in pain management. Anesthesiol Clin North America. 2003; 21:715–731.

12. Oyama IA, Rejba A, Lukban JC, Fletcher E, Kellogg-Spadt S, Holzberg AS, et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology. 2004; 64:862–865.

13. Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001; 166:2226–2231.

14. Hansen BL, Dunn GE, Norton P, Hsu Y, Nygaard I. Long-term follow-up of treatment for synthetic mesh complications. Female Pelvic Med Reconstr Surg. 2014; 20:126–130.

15. Adelowo A, Hacker MR, Shapiro A, Modest AM, Elkadry E. Botulinum toxin type A (BOTOX) for refractory myofascial pelvic pain. Female Pelvic Med Reconstr Surg. 2013; 19:288–292.