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]

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Summary

Introduction

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.

History of BoNT-A in LUTDs
Mechanism Action of BoNT-A on CPP
Reducing Pelvic Muscle Spasm and Pain
Reducing Neurogenic Inflammation
Clinical Application of BoNT-A in Pelvic Floor Muscle and Fascial Pain
Other Applications of BoNT-A in CPP
Adverse Events of BoNT-A injection in CPP
Findings
Conclusions
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