title: Botulinum toxin type A (BOTOX) for refractory myofascial pelvic pain.
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.
authors: Division of Urogynecology, Mount Auburn Hospital, Cambridge, MA, USA. aadelowo@mah.harvard.edu
authors: Amos
authors: A
authors: Adelowo
authors: Michele R
authors: MR
authors: Hacker
authors: Alex
authors: A
authors: Shapiro
authors: Anna Merport
authors: AM
authors: Modest
authors: Eman
authors: E
authors: Elkadry
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced; D005242:Fecal Incontinence / Q000139:chemically induced; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy*; D017699:Pelvic Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D016055:Urinary Retention / Q000139:chemically induced
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
references: Obstet Gynecol. 2004 Nov;104(5 Pt 1):922-5
references: 15516379
references: Eur Urol. 2009 Jan;55(1):100-19
references: 18823697
references: Obstet Gynecol. 2006 Oct;108(4):915-23
references: 17012454
references: J Reprod Med. 2006 Jun;51(6):467-70
references: 16846084
references: Urology. 2007 Jul;70(1):16-8
references: 17656199
references: Obstet Gynecol. 1996 Mar;87(3):321-7
references: 8598948
references: Aust N Z J Obstet Gynaecol. 2004 Feb;44(1):46-50
references: 15089868
references: Int Urogynecol J. 2011 Apr;22(4):413-8
references: 20976441
references: Eur J Pain. 2007 Jul;11(5):519-27
references: 17071119
references: Dis Colon Rectum. 1996 Oct;39(10):1107-11
references: 8831524
references: J Urol. 2000 Sep;164(3 Pt 1):692-7
references: 10953127
references: Curr Pain Headache Rep. 2007 Oct;11(5):359-64
references: 17894926