Botulinum toxin infiltrations versus local anaesthetic infiltrations in pelvic floor myofascial pain: Multicentre, randomized, double-blind study

Levesque, Amélie; Ploteau, Stéphane; Michel, Fabrice; Siproudhis, L.; Bautrant, Eric; Eggermont, Julie; Rabischong, B.; Volteau, Christelle; Perrouin‐Verbe, Marie‐Aimée; Labat, J.-J.

doi:10.1016/j.rehab.2019.12.009

Cited by 21 publications

(15 citation statements)

References 23 publications

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“…It can therefore be assumed that the pain reduction after BoNT/A infiltration was in general clinically important. The PGI-I results outperformed those reported in other studies, in which not all the patients described a subjective improvement associated with BoNT/A [12,13].…”

Section: Discussionsupporting

confidence: 47%

“…According to numerous published studies [10], BoNT/A infiltration may significantly relieve pain and improve quality of life, according to outcomes assessed by clinical questionnaires. However, the response to treatment is highly variable among patients; while some women report a substantial reduction in painful symptoms after BoNT/A infiltration, others do not perceive any improvement of their clinical condition [11,12] or even report a worsening of it [13]. The inability to know in advance whether the patient is a potential responder to botulinum toxin, as well as the absence of a significant improvement of CPP symptoms after treatment, can be frustrating for both the patient and the physician.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients’ Characteristics

Tarazona-Motes

Albaladejo-Belmonte

Nohales-Alfonso

et al. 2021

IJERPH

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The treatment of chronic pelvic pain (CPP) with botulinum neurotoxin type A (BoNT/A) has increased lately, but more studies assessing its effect are needed. This study aimed to evaluate the evolution of patients after BoNT/A infiltration and identify potential responders to treatment. Twenty-four women with CPP associated with dyspareunia were treated with 90 units of BoNT/A injected into their pelvic floor muscle (PFM). Clinical status and PFM activity were monitored in a previous visit (PV) and 12 and 24 weeks after the infiltration (W12, W24) by validated clinical questionnaires and surface electromyography (sEMG). The influence of patients’ characteristics on the reduction in pain at W12 and W24 was also assessed. After treatment, pain scores and the impact of symptoms on quality of life dropped significantly, sexual function improved and sEMG signal amplitude decreased on both sides of the PFM with no adverse events. Headaches and bilateral pelvic pain were risk factors for a smaller pain improvement at W24, while lower back pain was a protective factor. Apart from reporting a significant clinical improvement of patients with CPP associated with dyspareunia after BoNT/A infiltration, this study shows that clinical characteristics should be analyzed in detail to identify potential responders to treatment.

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Section: Discussionsupporting

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients’ Characteristics

Tarazona-Motes

Albaladejo-Belmonte

Nohales-Alfonso

et al. 2021

IJERPH

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“…The efficacy of BTX-A combined with 0.2% local anaesthetic ropivacaine hydrochloride injection (BTX group) with ropivacaine hydrochloride injection alone (LA group) for the treatment of pelvic floor myofascial syndrome and chronic pelvic pain showing that neither group exhibited any significant differences on day 60. However, the two groups showed an overall improvement in pain, meaning that intramuscular injection with ropivacaine hydrochloride alone was justified (Gorimanipalli et al, 2019;Levesque et al, 2021). The randomized clinical trials of BTX-A for myofascial pain has also been elaborated (Table 1).…”

Section: Myofascial Painmentioning

confidence: 99%

“…( Levesque et al, 2021) epicondylitis, suggesting the location of injection as a potential source of outcome heterogeneity (Song et al, 2020).…”

Section: P R E -P R O O Fmentioning

confidence: 99%

Advances in botulinum toxin type A for the treatment of pain

Jiang¹,

Huang²,

Yang³

et al. 2021

NRFHH

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<i>Clostridium botulinum</i> (CB) is a Gram-positive anaerobic bacterium and a significant cause of food spoilage. Foodborne botulism occurs worldwide every year and even lead to death from respiratory distress in severe cases after eating botulism-contaminated food. The pathogenicity of CB lies in its ability to produce a potent neurotoxin, “botulinum toxin (BTX)”, for which eight different subtypes have already been isolated so far. Botulinum toxin type A (BTX-A) is widely used to treat critical clinical issues due to its good affinity and tolerability. Studies have shown that BTX-A injections effectively treat myofascial pain, inflammatory pain, and neuropathic pain. The current article mainly reviews the latest research progress using BTX-A in pain treatment during two years.

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“… 6 , 7 However, the efficacy and rationale remain controversial. 8 Therefore, the identification of other mechanisms of MTrPs is crucial for the development of novel effective therapies.…”

Section: Introductionmentioning

confidence: 99%

Peripheral EphrinB1/EphB1 signalling attenuates muscle hyperalgesia in MPS patients and a rat model of taut band-associated persistent muscle pain

Jin

Zhao

et al. 2020

Mol Pain

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Background Myofascial pain syndrome (MPS) is an important clinical condition that is characterized by chronic muscle pain and a myofascial trigger point (MTrP) located in a taut band (TB). Previous studies showed that EphrinB1 was involved in the regulation of pathological pain via EphB1 signalling, but whether EphrinB1-EphB1 plays a role in MTrP is not clear. Methods The present study analysed the levels of p-EphB1/p-EphB2/p-EphB3 in biopsies of MTrPs in the trapezius muscle of 11 MPS patients and seven healthy controls using a protein microarray kit. EphrinB1-Fc was injected intramuscularly to detect EphrinB1s/EphB1s signalling in peripheral sensitization. We applied a blunt strike to the left gastrocnemius muscles (GM) and eccentric exercise for 8 weeks with 4 weeks of recovery to analyse the function of EphrinB1/EphB1 in the muscle pain model. Results P-EphB1, p-EphB2, and p-EphB3 expression was highly increased in human muscles with MTrPs compared to healthy muscle. EphB1 (r = 0.723, n = 11, P < 0.05), EphB2 (r = 0.610, n = 11, P < 0.05), and EphB3 levels (r = 0.670, n = 11, P < 0.05) in the MPS group were significantly correlated with the numerical rating scale (NRS) in the MTrPs. Intramuscular injection of EphrinB1-Fc produces hyperalgesia, which can be partially prevented by pre-treatment with EphB1-Fc. The p-EphB1 contents in MTrPs of MPS animals were significantly higher than that among control animals (P < 0.01). Intramuscular administration of the EphB1 inhibitor EphB1-Fr significantly suppressed mechanical hyperalgesia. Conclusions The present study showed that the increased expression of p-EphB1/p-EphB2/p-EphB3 was related to MTrPs in patients with MPS. This report is the first study to examine the function of EphrinB1-EphB1 signalling in primary muscle afferent neurons in MPS patients and a rat animal model. This pathway may be one of the most important and promising targets for MPS.

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Botulinum toxin infiltrations versus local anaesthetic infiltrations in pelvic floor myofascial pain: Multicentre, randomized, double-blind study

Cited by 21 publications

References 23 publications

Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients’ Characteristics

Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients’ Characteristics

Advances in botulinum toxin type A for the treatment of pain

Peripheral EphrinB1/EphB1 signalling attenuates muscle hyperalgesia in MPS patients and a rat model of taut band-associated persistent muscle pain

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