Abstract
Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months’ duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.
Highlights
Chronic pelvic pain (CPP) is defined as chronic or persistent pain perceived in the structures related to all organs in the pelvis for at least 6 months’ duration, including prostate, scrotum, urethra, bladder, vagina, rectum, and anus [1].The diagnosis of CPP is based on a patient’s history and physical examination
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), interstitial cystitis/bladder pain syndrome (IC/BPS), chemical cystitis, and pelvic floor muscle pain are categorized into CPP [1]
As recently as 2010, researchers began investigating Botulinum toxin A (BoNT-A) for the treatment of CPP related to different conditions including myofascial pain, chemical cystitis, and CP/CPPS [22,23,24]
Summary
Chronic pelvic pain (CPP) is defined as chronic or persistent pain perceived in the structures related to all organs in the pelvis for at least 6 months’ duration, including prostate, scrotum, urethra, bladder, vagina, rectum, and anus [1]. The European Urology Association guidelines classify patients with CPP according to the region where pain occurs (with or without a particular disease), pain system (urological, gynecological or musculoskeletal), and end-organ. Pain syndrome as identified from the history or examination (such as bladder, prostate, vulvar, or pelvic floor muscle). BoNT-A has been widely used to treat many dystonic diseases and neuropathic pain syndromes. These conditions include cervical dystonia, cerebral palsy, trigeminal neuralgia, chronic migraine, and complex regional pain syndrome [4,5,6]. BoNT-A effectively treats CPP, IC/BPS, and pelvic floor muscle pain [9]. For patients with refractory CPP, BoNT-A has promising effects, including antinociceptive, muscle relaxation, and anti-inflammatory activity.
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