Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles
Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles
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DOI：
10.1111/j.1479-828x.2004.00163.x
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发表时间：
2004-02-01
影响因子：
1.7
通讯作者：
Vancaillie, TG
中科院分区：
文献类型：
--
作者：
Jarvis, SK;Abbott, JA;Vancaillie, TG
目的：探讨A型肉毒毒素(Botox)肌注入盆底肌肉提上提肌是否能减轻疼痛症状，改善生活质量。设计：前瞻性队列研究。地点：澳大利亚悉尼一家三级转诊中心的门诊。样本：12名女性，年龄18-55岁，客观盆底肌肉张力增高，至少有2年慢性盆腔疼痛病史。方法：所有女性完成视觉模拟评分疼痛评估；有关膀胱和肠道症状和生活质量的问卷调查；以及具体检查。在清醒镇静状态下双侧耻骨直肠肌和耻尾肌注射3种不同稀释度的肉毒杆菌毒素40个单位。结果：视觉模拟量表评分中位数对楔形障碍(80比28；P=0.01)和痛经(67比28；P=0.03)有显著改善，对非经期盆腔疼痛(37分)和经痛(47比29分)无明显改善。盆底肌肉测压显示静息压力在第4周下降了37%，在第12周保持了25%的下降(P<；0.0001)。生活质量评分(EQ-5D和SF-12)在第12周较治疗前有所改善，但未达到统计学意义。性行为评分明显改善，不适感(4.8vs2.2；P=0.02)和习惯改善(0.2vs1.9，P=0.03)显著减少。这些结果不受稀释的影响。结论：有证据表明，有盆底肌肉高张力和盆腔疼痛的女性可能对盆底肌肉注射肉毒杆菌有反应。强烈建议进一步研究这种治疗慢性盆腔疼痛的新方法。
Objective: To investigate whether botulinum toxin type A (BOTOX) injected into the levator am muscles of women with objective pelvic floor muscle spasm decreases pain symptoms and improves quality of life.Design: A prospective cohort study.Setting: Outpatient clinic in a tertiary referral centre, Sydney, Australia.Sample: Twelve women, aged 18-55 years, with objective pelvic floor muscle hypertonicity and a minimum 2-year history of chronic pelvic pain were recruited.Methods: All women completed visual analog scale pain assessments; questionnaires relating to bladder and bowel symptoms and quality of life; and specific examinations. Forty units of BOTOX at three different dilutions were given bilaterally into the puborectalis and pubococcygeus muscles under conscious sedation.Results: Median visual analog scale scores were significantly improved for dysparcunia (80 vs 28; P = 0.01) and dysmenorrhea (67 us 28; P = 0.03), with non-significant reductions in non-menstrual pelvic pain (64 us 37) and dyschesia (47 vs 29). Pelvic floor muscles manometry showed a 37% reduction in resting pressure at week 4 and a 25% reduction was maintained at week 12 (P < 0.0001). Quality of life scores (EQ-5D and SF-12) were improved from baseline at week 12, but did not reach statistical significance. Sexual activity scores were markedly improved, with a significant reduction in discomfort (4.8 vs 2.2; P = 0.02) and improvement in habit (0.2 vs 1.9, P = 0.03). These results were not influenced by dilution.Conclusion: There is evidence from the present pilot study suggesting that women with pelvic floor muscles hypertonicity and pelvic pain may respond to BOTOX injections into the pelvic floor muscles. Further research into this novel treatment of chronic pelvic pain is strongly recommended.