Botulinum Toxin-A Injection Treat Chronic Pelvic Pain Syndrome

Botulinum Toxin-A Injection Treat Chronic Pelvic Pain Syndrome: History

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Subjects: Urology & Nephrology

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Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A (BTX-A) may represent a promising therapeutic strategy for these patients. This entry summarizes the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A pooled meta-analysis of the included studies was performed considering only patients underwent BTX-A injection and comparing pain scores evaluated at baseline and at the last available follow up. We found that BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.

chronic pelvic pain
botulinum toxin A
bladder pain syndrome
prostate pain syndrome
scrotal pain
myofascial pain

1. Introduction

Chronic pelvic pain (CPP) is defined as a chronic or persistent pain perceived in structures related to the pelvis lasting for at least six months. It is often associated with negative cognitive, behavioral, sexual, and emotional consequences as well as with symptoms suggestive of lower urinary tract, sexual, bowel, pelvic floor or gynecological dysfunction. When there is no evidence of proven underlying disease accounting for the pain, it refers to a chronic pelvic pain syndrome (CPPS).

The management of CPPS is based on pharmacological and non-pharmacological interventions such as psychotherapy, physiotherapy, drugs and invasive treatments.

Botulinum toxin is a neurotoxin currently used for the treatment of various pain disorders. Several studies have addressed the role of BTX-A in the treatment of CPPS, even though with no definitive conclusion and subsequentially no absolute indication in favour of its efficacy can be assumed. Aim of this systematic review is to investigate the efficacy of BTX-A injection in CPPS management.

2. Botulinum Toxin-A Injection Treat Chronic Pelvic Pain Syndrome

We reviewed the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. Comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed from English-language articles published between January 2000 and October 2021. The primary outcome was to evaluate pain improvement after BTX-A treatment. A pooled meta-analysis of the included studies was performed considering only patients underwent BTX-A injection and comparing pain scores evaluated at baseline and at the last available follow up.

After screening 1001 records, 18 full-text manuscripts were selected, comprising 13 randomised clinical trials and 5 comparative studies. They covered 896 patients and several subtypes of CPPS: interstitial cystitis/bladder pain syndrome (IC/BPS), chronic prostatitis/prostate pain syndrome (CP/PPS), chronic scrotal pain, gynecological pelvic pain (GPP) and myofascial pelvic pain. A narrative synthesis of the main findings for each studies was provided. However, the clinical and methodological heterogeneity of studies included regarding the study design, the definition of CPPS subtype, intervention and control groups, number and sexes of patients, type and dose of drug administered, number and location of injections delivered, outcome measured and time of follow up, make it difficult to do an overall estimation of the effect of BTX-A on pain and other functional outcomes of various CPPS subtypes.

For the pooled meta-analysis, we included 21 cohorts of BTX-A treated patients coming from 14 studies (447 patients). A significant reduction in pain scores, related to the scale adopted, was showed in the overall cohort (p<0.001). Considering treated patients grouped according to CPPS subtypes, we found a significant improvement in pain relief in IC/PBS (p<0.001, 192 patients), CP/PPS (p=0.005, 73 patients), and GPP (p<0.001, 120 patients), even if some studies did not reach a significant improvement when independently considering.

3. Conclusion

The methodological heterogeneity of the included studies and the main data reported showed that, even if chronic pelvic pain as well as urinary and sexual symptoms may benefit often from the use of BTX-A injected in pelvic structures, with low rates of complications, the current level of evidence is too low to provide recommendations on its use in daily clinical practice.

However, we showed a pooled meta-analysis of prospective studies demonstrating a statistically significant pain relief after BTX-A injection compared to baseline values for some specific CPPS subtypes.

Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.

This entry is adapted from the peer-reviewed paper 10.3390/toxins14010025

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