Botulinum toxin injection for chronic pelvic pain: A systematic review

Abstract

Introduction: Botulinum toxin has proven therapeutic effects in alleviating pain in several myofascial disorders, with an expanding potential in chronic pelvic pain. The objective of this systematic review is to evaluate the efficacy and safety of botulinum toxin injection as an off-label treatment for female chronic pelvic pain.

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

“…According to the literature, the most frequent adverse effects after BoNT/A infiltration are constipation, stress urinary incontinence, faecal incontinence and localized pain and/or bleeding from the injection site [10,14]. Unlike all the other studies published in the field [10], no adverse events were found after treatment, so that the protocol followed in the present study for BoNT/A infiltration can be regarded as a suitable option to improve the patients' clinical status while avoiding secondary effects.…”

“…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. A recent review on the use of the toxin to treat CPP suggested that factors such as concurrent pain conditions could significantly confound BoNT/A's effectiveness [14]. Nevertheless, no study has yet analyzed the influence of the patients' clinical characteristics and medical history on their response to this treatment in CPP.…”

Botulinum toxin for chronic pain: What's on the horizon?

“…Pain reduction in BoNT group was significantly greater than placebo Trigeminal neuralgia 1,5,27 Postherpetic neuralgia Phantom limb pain and residual limb pain 1,5 Case series and placebocontrolled RCT Both BoNT and placebo showed reduction of pain; no statistical difference noted Complex regional pain syndrome 5,[38][39][40] Case series and RCT Reduction of pain with BoNT injections…”

“…In a 2020 systematic review (including 12 observational studies and 5 randomized controlled trials) of BoNT for treatment of chronic pelvic pain, the quality of evidence varied widely. 38 Observational studies showed good benefit, but only 1 randomized trial showed statistical difference with the use of BoNT for pelvic pain. No serious adverse events were reported in any of the studies.…”

“…38 Chronic pelvic pain can be caused by a number of different conditions, and more high-quality research for BoNT is needed, focusing on specific causes. 5,38 Complex regional pain Complex regional pain syndrome (CRPS) can be a debilitating condition that causes pain, sympathetic dysregulation, and central nervous system sensitization, often related to a traumatic event. Incidence is reported as 5 to 26 per 100,000, although it most likely is severely underdiagnosed.…”