A critical review of interventional treatments for myofascial pelvic pain

Abstract

Chronic pelvic pain affects between 6% and 25% of women. It is a complex condition that has multifactorial etiologies, including but not limited to conditions arising from the gynecologic, urologic, gastrointestinal, musculoskeletal, neurologic, and psychologic systems. In this literature review, we examine and summarize evidence for interventional treatments compared to conservative treatments for women with musculoskeletal or myofascial pelvic pain. Searches were performed in PubMed and Embase databases. Studies were included if they were randomized controlled trials with a treatment arm of physical therapy, dry needling, trigger point injection (TPI), or injection with botulinum toxin. A total of 106 studies were returned with our search terms, and six articles were included in this review. These studies suggest that pelvic floor physical therapy, dry needling of abdominal wall trigger points, and TPI to abdominal wall and pelvic floor trigger points have some evidence as being effective for treatment of pelvic pain. The evidence for treatment with botulinum toxin was not as robust and also had higher rates of adverse events when compared to other interventions. Most of these studies are limited by small sample sizes and varied baseline demographics, which makes generalization of these findings to different patient populations difficult. In general, treatments for myofascial pelvic pain are low-risk and are effective in reducing myofascial pelvic pain.

Keywords

• botulinum toxin injection
• dry needling
• pelvic myofascial pain
• pelvic pain
• pelvic rehabilitation
• physical medicine and rehabilitation
• physical therapy
• trigger point injection