title: Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain.
abstract: 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.
  
  
  
  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.
  
  
  
  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%).
  
  
  
  Botox combined with soft tissue myofascial release physical therapy under anesthesia can be effective in treating women with chronic pelvic pain secondary to MFPP.
authors.affiliation: Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
authors.forename: Gabriela E
authors.initials: GE
authors.lastname: Halder
authors.affiliation: Department of Female Pelvic Floor Medicine and Reconstructive Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Scott
authors.affiliation: Department of Female Pelvic Floor Medicine and Reconstructive Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Wyman
authors.affiliation: Morsani School of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Nelsi
authors.initials: N
authors.lastname: Mora
authors.affiliation: Center for Comparative Effectiveness Research and Evidence-based Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Branko
authors.initials: B
authors.lastname: Miladinovic
authors.affiliation: Department of Female Pelvic Floor Medicine and Reconstructive Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Bassaly
authors.affiliation: Department of Female Pelvic Floor Medicine and Reconstructive Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Lennox
authors.initials: L
authors.lastname: Hoyte
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000009:adverse effects / Q000379:methods*; D009209:Myofascial Pain Syndromes / Q000628:therapy*; D010147:Pain Measurement / Q000379:methods; D017699:Pelvic Pain / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: Botox; Myofascial pain; Pelvic pain; Therapy