scholarly journals Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment

2019 ◽  
Vol 44 (9) ◽  
pp. 886-892 ◽  
Author(s):  
Hannah K Tandon ◽  
Pamela Stratton ◽  
Ninet Sinaii ◽  
Jay Shah ◽  
Barbara I Karp
Keyword(s):  
Botulinum Toxin ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Pelvic Floor Muscle ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Pain Medication ◽  
Muscle Spasm ◽  
Open Label ◽  
Topical Anesthetic

Background and objectivesMany women with endometriosis continue to have pelvic pain despite optimal surgical and hormonal treatment; some also have palpable pelvic floor muscle spasm. We describe changes in pain, spasm, and disability after pelvic muscle onabotulinumtoxinA injection in women with endometriosis-associated pelvic pain, a specific population not addressed in prior pelvic pain studies on botulinum toxin.MethodsWe present an open-label proof-of-concept case series of women with surgically diagnosed endometriosis. Under conscious sedation and with topical anesthetic, 100 units of onabotulinumtoxinA was injected transvaginally into pelvic floor muscle spasm areas under electromyography guidance. Changes in pain intensity, muscle spasm, disability, and pain medication use were assessed at periodic visits for up to 1 year after injection.ResultsThirteen women underwent botulinum toxin injection and were followed for at least 4 months. Before injection, 11 of the 13 women had spasm in >4/6 assessed pelvic muscles and reported moderate pain (median visual analog scale (VAS): 5/10; range: 2–7). By 4–8 weeks after injection, spasm was absent/less widespread (≤3 muscles) in all (p=0.0005). Eleven rated their postinjection pain as absent/mild (median VAS: 2; range: 0–5; p<0.0001); 7/13 reduced pain medication. Disability decreased in 6/8 women with at least moderate preinjection disability (p=0.0033). Relief lasted 5–11 months in 7 of the 11 patients followed for up to 1 year. Adverse events were mild and transient.ConclusionsThese findings suggest pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain. Botulinum toxin injection may provide meaningful relief of pain and associated disability.Trial registration numberNCT01553201

Persistent Diplopia in Visually Mature Patients. Is it Intractable or something else? A Review and Case Series

2017 ◽  
pp. 90-108
Keyword(s):  
Botulinum Toxin ◽  
Extraocular Muscle ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Sensory Adaptation ◽  
Single Vision ◽  
Injection Treatment ◽  
Vision Therapy ◽  
Extraocular Muscle Surgery

Diplopia is described as being intractable when there is inability to both fuse the two images and suppress the second image. Intractable diplopia persists despite achieving ocular alignment using either prisms, lenses,vision therapy,extraocular muscle surgery, or botulinum toxin injection. Treatment usually resorts to occluding or fogging the patient’s nondominant eye. Often times, however, adults having other causative mechanisms for supposedly persistent diplopia are able to achieve comfortable single vision with treatment that either establishes fusion or reactivates a preexisting sensory adaptation. This case series reviews these other causes of diplopia.

scholarly journals Attachment of the levator ani muscle extends to the superior ramus of the pubic bone through electrophysiological and anatomical examinations

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hung-Yen Chin ◽  
Chih-Wei Peng ◽  
Ming-Ping Wu ◽  
Chih-Hwa Chen ◽  
Yu-Ting Feng ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Pelvic Floor Muscle ◽  
Levator Ani ◽  
Pubic Bone ◽  
Levator Ani Muscle ◽  
Cadaver Dissection ◽  
Inferior Border ◽  
Stimulation Of

AbstractMyofascial pelvic pain (MFPP) of pelvic floor muscles is a common cause of chronic pelvic pain (CPP). The pathological mechanisms and treatments of MFPP are complex and still unclear until now. The levator ani muscle (LAM) is the major pelvic floor muscle. The purpose of this study was to examine the fascia and attachment of LAM through the electromyogram (EMG) and cadaver dissection. Electrophysiological stimulation of the obturator fascia above the arcus tendinous levator ani (ATLA) could trigger contraction and electrophysiological changes in LAM insertion. The LAM of embalmed adult cadavers was examined especially in the area above the ATLA. Some skeletal muscle fibers were found above the ATLA within the obturator fascia and were confirmed by Masson’s trichrome section staining. Our electromyography (EMG) and anatomical data implied that the attachment of LAM aponeurosis extended beyond ATLA to the inferior border of the superior ramus of the pubic bone. The new discovered attachment of LAM could provide a reference position for clinical diagnosis and treatment of MFPP or CPP.

Pelvic-floor relaxation techniques using biofeedback – more effective therapy for chronic prostatitis/chronic pelvic pain syndrome

2020 ◽  
Vol 13 (6) ◽  
pp. 454-459
Author(s):  
Manish Pandey ◽  
Vaibhav Shrivastava ◽  
Vijay Patidar ◽  
Sabby Dias ◽  
Sameer Trivedi
Keyword(s):  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Prostatitis ◽  
Pelvic Floor Muscle ◽  
Muscle Relaxation ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Group A ◽  
Group B

Objective: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pelvic pain and voiding symptoms, the management of which is challenging. The present study was designed to assess the efficacy of biofeedback and pelvic-floor relaxation treatment for CP/CPPS. Methods: A total of 84 patients diagnosed with CP/CPPS were randomly assigned to one of the two groups: conventional therapy (group A) and pelvic-floor muscle relaxation and biofeedback (group B). The Biofeedback and Electrical Stimulation apparatus was used for pelvic-floor muscle electrical stimulation and relaxation with biofeedback. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores were evaluated at the start of therapy, after 3 months of treatment and at 6 months (3 months after last treatment received). Results: At 3 months, patients in both groups had a significant decrease (improvement in symptoms) in NIH-CPSI scoring. However, at 6 months, only 19 (47.5%) patients in group A maintained a fall in NIH-CPSI score >6 compared with 37 (94.8%) patients in group B ( p<0.05). At 6 months, there was significant decrease in NIH-CPSI score in group B, whereas in group A, scores had increased (worsening of symptoms). Conclusions: Pelvic-floor muscle relaxation and biofeedback training is a safe and effective treatment for CP/CPPS with sustained efficacy.

Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache

2008 ◽  
Vol 123 (4) ◽  
pp. 412-417 ◽  
Author(s):  
J A de Ru ◽  
J Buwalda
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Effective Means ◽  
Case Series ◽  
Botulinum Toxin Type ◽  
Toxin A ◽  
Tertiary Referral Centre ◽  
Corrugator Supercilii

AbstractObjective:To describe our results with botulinum toxin type A injection for headache in carefully selected patients, and to present the rationale behind this therapy.Setting:Tertiary referral centre.Patients and methods:This article describes a case series of 10 consecutive patients with frontally localised headache, whose pain worsened when pressure was applied at the orbital rim near the supratrochlear nerve. The patients received a local anaesthetic nerve block with Xylocaine 2 per cent at this site. If this reduced the pain, they were then offered treatment with botulinum toxin.Intervention:Injection with 12.5 IU of botulinum toxin A into the corrugator supercilii muscle on both sides (a total of 25 IU).Main outcome measure:Pain severity scoring by the patients, ranging from zero (no pain) to 10 (severe pain) on a verbal scale.Results:Following injection, all patients had less pain for approximately two months. This treatment did not appear to have lasting side effects.Conclusion:Xylocaine injection is a good predictor of the effectiveness of botulinum toxin injection into the corrugator muscle as treatment of frontally localised headache. We hypothesise that this pain is caused by entrapment of the supratrochlearis nerve in the corrugator muscle. Furthermore, we found botulinum toxin injection to be a safe and effective means of achieving pain relief in this patient group.

Botulinum toxin injection for chronic pelvic pain: A systematic review

2020 ◽  
Vol 99 (12) ◽  
pp. 1595-1602
Author(s):  
Fang Yuan Luo ◽  
Maryam Nasr‐Esfahani ◽  
John Jarrell ◽  
Magali Robert
Keyword(s):  
Systematic Review ◽  
Botulinum Toxin ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Botulinum Toxin Injection
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