Presentation Authors: Jamie Bartley*, Lansing, MI, Laura Nguyen, Hamilton, Canada, Deborah Hasenau, Jason Gilleran, Larry Sirls, Esther Han, Lauren Tenneyson, Kenneth Peters, Royal Oak, MI
Introduction: Chronic pelvic pain in women is often due to pelvic muscle dysfunction and hypertonicity. In this study we compared outcomes of patients with chronic pelvic pain undergoing transvaginal trigger point injections (TPI) with triamcinolone (steroid) vs. onabotulinumtoxinA (Botox).
Methods: A prospective double-blind study was conducted. Patients were randomized (1:1) to receive in-office pelvic floor muscle injections with either a mixture of triamcinolone and ropivacaine followed by saline or injections of ropivacaine followed by a mixture of Botox 200 units and saline. Three bilateral injections were performed on each side of the pelvic floor. Statistical analysis compared the treatment groups at baseline and 1-month, 3-month and 6-month post-injection.
Results: Twenty-one patients underwent TPI (11 steroid, 10 Botox). Primary diagnosis included myalgia, urinary system related symptoms, muscle spasms, and chronic pelvic pain. There was no statistical difference in baseline demographics or prior treatment. The median pre-injection pain score for the Steroid group was lower than the Botox group (5 (range: 4-7) vs 6 (range: 5-8), respectively; p= 0.015). At 1 month, there was no difference in median Numerical Rating Scale (NRS) pain scores between groups; Steroid: 5 (range 3-8, n=10) vs. Botox: 4.5 (range 2-7, n=9); p = 0.82. The change in median NRS scores between 1 month and baseline was no different between groups (Steroid: -1 (range -2 to +3) vs. Botox: -2 (range -4 to 0); p = 0.072. The numbers for 3 and 6 months were too small for comparison but are presented in Table 1. There is no difference between groups at baseline or at one month follow up on Brief Pain Inventory (BPI) measures or GRA measures. 90% (Steroid) and 89% (Botox) at 1month and 100% at 3 and 6 months (both groups) would recommend the same TPI to a friend. Regardless of the initial treatment received, approximately 40% of the patients from each group elected to receive steroid TPI at 1-month follow-up.
Conclusions: There was no difference in NRS pain scores at 1 month in patients that received TPI with triamcinolone compared to Botox. Patients in both groups would recommend TPI equally to a friend.
Source of Funding: Allergan and Beaumont, Department of Urology, Philanthropy