title: Improvement in pelvic pain with botulinum toxin type A - Single vs. repeat injections.
abstract: The aim of this prospective study was to report the outcomes of pain and vaginal pressures of successive botulinum toxin type A injections for women with objective pelvic floor muscle overactivity and a two-year history of pelvic pain. Between 2005 and 2008, 37 women underwent injection of 100 IU of botulinum toxin type A into the puborectalis and pubococcygeous muscles with dysmenorrhoea, dyspareunia, dyschesia, and non-menstrual pelvic pain assessed using a visual analogue scale (VAS), and vaginal pressure measured by vaginal manometry, at 0, 4, 12 and 26 weeks from each injection. 26 women (70%) had one injection of botulinum toxin type A and 11 (30%) had 2 or more injections. The second injection was performed at the earliest at 26 weeks after the first, with subsequent injections having a median time to re-injection of 33.4 weeks (range 9.4-122.7 weeks). Single and repeated injections both demonstrated a statistically significant reduction in dyspareunia by VAS scores from 54 to 30 in the single injection group and from 51 to 23 in the multiple injection group (p = .001), non-menstrual pelvic pain VAS from 37 to 25 (p = .04), as well as vaginal pressures; 40 versus 34 cm H(2)O (p = .02). No statistically significant difference in dysmenorrhoea or dyschesia was observed for either group from their baseline scores. Multiple injections of botulinum toxin type A in women with pelvic floor muscle overactivity provide significant relief from dyspareunia and non-menstrual pelvic pain. The upper limit between re-injection is not yet determined, nor is the maximum number of treatments. Clinical outcomes for single and subsequent injection of botulinum toxin type A for recurrent pelvic pain are equivalent. Women who have had benefit from a single injection of botulinum toxin type A can be reassured that if symptoms reoccur, repeated injections can be expected to be equally efficacious.
authors.affiliation: Department of Endo-Gynaecology, Royal Hospital for Women, Sydney, Australia. erin.nesbitt-hawes@sesiahs.health.nsw.gov.au
authors.forename: E M
authors.initials: EM
authors.lastname: Nesbitt-Hawes
authors.forename: H
authors.initials: H
authors.lastname: Won
authors.forename: S K
authors.initials: SK
authors.lastname: Jarvis
authors.forename: S D
authors.initials: SD
authors.lastname: Lyons
authors.forename: T G
authors.initials: TG
authors.lastname: Vancaillie
authors.forename: J A
authors.initials: JA
authors.lastname: Abbott
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004414:Dyspareunia / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects / Q000502:physiology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D017773:Pelvic Floor / Q000503:physiopathology; D017699:Pelvic Pain / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A