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Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain
Carolyn F Langford1, Szilvia Udvari Nagy, Gamal M Ghoniem
1Section of Voiding Dysfunction, Female Urology and Reconstruction, Department of Urology, Cleveland Clinic, Weston, Florida 33331, USA. langfoc2@ccf.org
Aims:
We conducted this study to examine the role of trigger point injections in females with chronic pelvic pain (CPP) of at least 6 months duration and specific levator ani trigger points.
Methods:
This prospective study included 18 consecutive female patients with CPP and specific palpable levator ani trigger points. Pain was evaluated before and after trigger point injection on a Visual Analog Scale (VAS). Patient global satisfaction (PGS) and cure rates (PGC) were also measured by a VAS on a scale of 0-100%. The trigger points were identified manually by intravaginal palpation of the levator ani bilaterally. A mixture of 10 cc of 0.25% bupivacaine, 10 cc of 2% lidocaine and 1 cc (40 mg) of triamcinolone was used for injection of 5 cc per trigger point. A 5.5'' Iowa trumpet pudendal needle guide was used for injection. All but one injection were performed in the office setting without sedation. Pelvic floor muscle exercises were taught for use after injection. Success was defined as a decrease in pain as measured by a VAS of 50% or more, as well as PGS and PGC scores of 60% or greater. There was a mean follow up of 3 months after trigger point injection.
Results:
Thirteen of 18 women improved with the first trigger point injection resulting in a comprehensive success rate of 72%. Six (33%) of 18 women were completely pain free.
Conclusion:
In the management of CPP, a non-surgical office-based therapy such as trigger point injections can be effective in selected patients.
