Botulinum Toxin for the Treatment of Genital Pain Syndromes

Romito, Silvia; Bottanelli, Mara; Pellegrini, Maria Antonietta; Vicentini, Silvana; Rizzuto, Nicole; Bertolasi, Laura

doi:10.1159/000079620

Cited by 53 publications

(24 citation statements)

References 28 publications

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“…There was fair evidence of a lack of efficacy for botulinum toxin injections. [33][34][35][36][37] The body of evidence for other injections was poor; there was insufficient evidence regarding: steroid and "caine"-drug mixed injections, 38,39 multilevel nerve blocks, 40 intramuscular interferon, 41,42 and intralesional interferon. 43,44 Topical Applications.…”

Section: Vestibulodynia Resultsmentioning

confidence: 99%

Vulvodynia Interventions—Systematic Review and Evidence Grading

Andrews¹

2011

Obstetrical &Amp; Gynecological Survey

104

111

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After completion of this educational activity, the obstetrician/gynecologist should be better able to identify potential causes of vulvar pain to facilitate diagnosis of vulvodynia and vestibulodynia, distinguish between the symptoms of localized, provoked vulvodynia and generalized unprovoked vulvodynia to select the most appropriate therapies, evaluate the efficacy of surgical and nonsurgical interventions for the treatment of generalized unprovoked and localized, provoked vulvodynia. In addition, assess the benefits and risks of interventional therapies for vulvodynia and vestibulodynia to improve patient care.

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Section: Vestibulodynia Resultsmentioning

confidence: 99%

Vulvodynia Interventions—Systematic Review and Evidence Grading

Andrews¹

2011

Obstetrical &Amp; Gynecological Survey

104

111

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“…Studies utilizing transvaginal injection of trigger points are limited but predominantly include the attempts at relief of levator ani muscle spasm using botulinum Neurourology and Urodynamics DOI 10.1002/nau toxin A, utilizing the theory that paralysis of a spastic levator muscle will relieve pain [Romito et al, 2004;Fitzgerald et al, 2005;Thomson et al, 2005]. A study by Jarvis et al [2004] showed signi¢cant improvement on VAS in 12 women with the use of botulinum toxin A using three di¡erent dilutions [Thomson et al, 2005].…”

Section: Discussionmentioning

confidence: 99%

Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain

Langford

Nagy

Ghoniem

2007

Neurourology and Urodynamics

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Aims: 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 speci¢c levator ani trigger points. Methods: This prospective study included 18 consecutive female patients with CPP and speci¢c 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 aVAS on a scale of 0^100%. The trigger points were identi¢ed 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 00 Iowa trumpet pudendal needle guide was used for injection. All but one injection were performed in the o⁄ce setting without sedation. Pelvic £oor muscle exercises were taught for use after injection. Success was de¢ned 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 ¢rst trigger point injection resulting in a comprehensive success rate of 72%. Six (33%) of 18 women were completely pain free. Conclusion: In the management of CPP, a non-surgical o⁄ce-based therapy such as trigger point injections can be e¡ective in selected patients. Neurourol. Urodynam. 26: 59^62, 2007. ß 2006

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“…Our patient also responded well to 3-monthly repeated BT-A injections. In vaginismus and genital pain syndromes, local BT-A treatment relieves spasms [3, 6,11]. Possible reasons why our patient had a shorter-lasting response to BT-A than previously reported cases (3 months versus > 12) [6] could be that we injected BT-A at a lower dose or she had more severe LA spasms because of abnormal motor inhibitory mechanisms.…”

mentioning

confidence: 77%