A Novel, Non-opioid Treatment for Chronic Pelvic Pain in Women with Previously Treated Endometriosis Utilizing Pelvic-Floor Musculature Trigger-Point Injections and Peripheral Nerve Hydrodissection.

BACKGROUND: Endometriosis is the abnormal growth of uterine tissue outside the uterine cavity that can cause chronic pain, dysmenorrhea, and dyspareunia. Although the disease is common and nonmalignant in nature, the symptoms can severely impact function and quality of life. Treatment options for endometriosis are limited and not well understood despite a growing need. OBJECTIVE: To determine the effectiveness of pelvic-floor musculature trigger-point injections and peripheral nerve hydrodissection in treating endometriosis symptoms, associated pain, and pelvic functionality. DESIGN: Retrospective longitudinal study case series. SETTING: Private practice. PATIENTS: Sixteen female patients with biopsy-confirmed endometriosis. INTERVENTIONS: Ultrasound-guided pelvic-floor trigger-point injections and peripheral nerve hydrodissection performed once a week for 6 weeks. MAIN OUTCOME MEASUREMENTS: Pelvic pain intensity as measured pretreatment and posttreatment by the 0 to 10 Visual Analogue Scale (VAS) and the Functional Pelvic Pain Scale (FPPS). RESULTS: Pretreatment, the mean VAS score was 6.0 (standard deviation [SD] 2.7), and posttreatment the mean VAS score was 2.9 (SD 2.6); P < .05, 95% confidence interval (CI) 1.16 to 4.97. The mean total FPPS score before treatment was 14.4 (SD 5.2) and posttreatment it was 9.1 (SD 5.8); P < .05, 95% CI 1.34 to 9.28. Analysis of the subcategories within the FPPS indicated that the improvement was statistically significant in the categories of intercourse, sleeping, and working. In the category of intercourse, the mean change in score after treatment was 1.3 (P < .05, 95% CI 0.26-2.31). In the category of sleeping, the mean change in score after treatment was 1.2 (P < .05, 95% CI 0.32-1.99). In the category of working, the mean change in score after treatment was 0.9 (P < .05, 95% CI 0.18-1.53). CONCLUSIONS: Analysis suggests that the treatment was effective at relieving pain related to endometriosis; it also reflected promise in improving overall pelvic function, particularly in relation to intercourse, working, and sleeping.

A novel, nonopiod-based treatment approach to men with urologic chronic pelvic pain syndrome using ultrasound-guided nerve hydrodissection and pelvic floor musculature trigger point injections.

INTRODUCTION: Urological chronic pelvic pain syndrome (UCPPS) represents a group of pain symptoms relating to patients with pelvic pain for which treatment is largely unsatisfactory. The objective of this study is to analyze the effects of a novel treatment strategy in males suffering from UCPPS. METHODS: This retrospective, institutional review board-approved study analyzed eight male patients aged 24 to 61 with UCPPS. All the patients had a trial of antibiotic therapy, NSAIDs, and pelvic floor physical therapy before the study. The Visual Analog scale (VAS) and Functional Pelvic Pain scale (FPPS) were collected pretreatment. While continuing physical therapy, patients underwent weekly ultrasound-guided pelvic floor trigger point injections to the iliococcygeus, pubococcygeus, and puborectalis with lidocaine 1%. Concomitantly, patients received peripheral nerve hydrodissection performed on the pudendal nerve and the posterior femoral cutaneous nerve. The first two injections combined 1% lidocaine with dexamethasone, while the next four injections consisted of 1% lidocaine with traumeel (a homeopathic, plant-derived anti-inflammatory medication). At the 6-week follow-up, each patient retook the VAS and FPPS. RESULTS: The mean age of our patients was 31.8 years and the average duration of symptoms of the UCPPS was 21 months. Pretreatment, the mean VAS was 3.3 (STD 1.7) and the mean VAS posttreatment was 1.8 (STD 1.4); P < .05; 95% CI, 0.73 to 2.27. The mean FPPS pretreatment was 11.0 (STD 8.0) and the mean FPPS posttreatment was 6.3 (STD 5.3); P < .05; 95% CI, 0.03 to 9.22. CONCLUSION: Our results show promise for a novel, nonopioid-based treatment for UCPPS.