title: Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain.
abstract: OBJECTIVE
  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 specific levator ani trigger points.
  
  
  METHODS
  This prospective study included 18 consecutive female patients with CPP and specific 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 a VAS on a scale of 0-100%. The trigger points were identified 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'' Iowa trumpet pudendal needle guide was used for injection. All but one injection were performed in the office setting without sedation. Pelvic floor muscle exercises were taught for use after injection. Success was defined 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 first trigger point injection resulting in a comprehensive success rate of 72%. Six (33%) of 18 women were completely pain free.
  
  
  CONCLUSIONS
  In the management of CPP, a non-surgical office-based therapy such as trigger point injections can be effective in selected patients.
authors.affiliation: Section of Voiding Dysfunction, Female Urology and Reconstruction, Department of Urology, Cleveland Clinic, Weston, Florida 33331, USA. langfoc2@ccf.org
authors.forename: Carolyn F
authors.initials: CF
authors.lastname: Langford
authors.forename: Szilvia
authors.initials: S
authors.lastname: Udvari Nagy
authors.forename: Gamal M
authors.initials: GM
authors.lastname: Ghoniem
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001004:Anus Diseases / Q000150:complications*; D002045:Bupivacaine / Q000008:administration & dosage*; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008012:Lidocaine / Q000008:administration & dosage; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010173:Palpation; D017699:Pelvic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D013035:Spasm / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage; D014621:Vagina
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D008012:Lidocaine; D002045:Bupivacaine