Retrospective Multicenter Review of Efficacy and Practices of Botulinum Toxin a Trigger Point Injections for Chronic Pelvic Pain

INTRODUCTION: Chronic pelvic pain (CPP) is defined by the American College of Obstetricians presence of concomitant pudendal nerve block; and treatment setting (clinic versus operating room). Kruskal–Wallis and chi-square tests were performed to assess for statistical significance which was defined as p<0.05. RESULTS: Patients who received trigger point injections with Botox (N=69) had overall fewer repeat injections and a statistically significant increase in the amount of time between injections (148 days vs 112 days, p value 0.04731) compared to the non-Botox group (N=103). The average dose used was approximately 150 units of Botox with a range from 50 units to 500 units and a median dose of 100 units. Approximately 75% of patients who received Botox trigger-point injections also received concomitant pudendal nerve blocks. Approximately 80% of patients who received Botox trigger-point injections were treated in the operating room. Only 10% of patients in both groups underwent pelvic floor physical therapy during the study period. CONCLUSIONS: The results of this study may indicate a longer duration of treatment effect of trigger-point injections containing botulinum toxin A. Further research is needed to create a standardized protocol for botulinum toxin A trigger-point injections with concurrent use of validated questionnaires to evaluate patient reported outcomes following treatment. Patient education is required to ensure understanding that trigger-point injections are optimally used as an adjunct to pelvic floor physical therapy for long-term benefit.