ESRA Academy. Zavridis P. Sep 9, 2016; 138290; 0114 Topic: PAIN THERAPY (ACUTE - CHRONIC)
Dr. Periklis Zavridis
Dr. Periklis Zavridis
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Background and Aims:

Myofascial pain is significant source of morbidity among patients with chronic pelvic pain, and may be treated with botulinum toxin A (Botox) injection into pelvic floor muscles. The present study aims to evaluate safety and efficacy of CT-guided intramuscular injection of Botox for this treatment.


Between 07/2013 and 03/2016, n = 57 patients with myofascial pelvic pain were treated with CT-guided pelvic floor muscle Botox injections in 76 treatment sessions. Following scout CT, A 22 gauge needle was placed into each target muscle under CT fluoroscopic guidance. Botox suspended in saline was injected into the piriformis, obturator internus, and/or levator ani (n = 53, 6, and 12 treatments, respectively). Visual analog scale pain scores (on a 10-point scale) were compared immediately pre- and post-procedure, and at follow-up clinic appointments. 


Successful injection of full dose of Botox to the target muscle was accomplished in all cases, conferring technical success rate of 100%. There were no major or minor complications by SIR criteria as assessed immediately post procedure or at follow up clinic appointments, including no patient report of urinary or fecal incontinence in any case. Lower visual analog pain scores were reported post procedure following 68% of treatments, with the difference in scores demonstrating statistical significance (p = 0.03). 


CT-guided percutaneous injection of Botox into pelvic floor muscles for management of myofascial pelvic pain is safe technique that demonstrates similar efficacy and lower complication rates as compared to those published for non-CT-guided injections.

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