Botulinum Toxin for Pelvic Pain in Women With Endometriosis

National Institutes of Health (NIH)

Status and phase

Completed

Phase 2

Phase 1

Conditions

Quality of Life

Chronic Pelvic Pain

Endometriosis

Pelvic Muscle Spasm

Treatments

Drug: Placebo

Drug: Botulinum toxin (BoNT)

Study type

Interventional

Funder types

NIH

Identifiers

NCT01553201

120083

12-N-0083

Details and patient eligibility

About

Background:

Some women with endometriosis have chronic pelvic pain. This pain may be caused by spasms of the pelvic floor muscles. These spasms can be detected by an examination. Studies suggest that botulinum toxin can help treat problems caused by muscle spasms. Researchers want to see if botulinum toxin injections into the pelvic floor muscles can decrease pain and spasms in women with pelvic pain.

Objectives:

To see if botulinum toxin can relieve pain from pelvic floor spasm in women with pelvic pain.

Eligibility:

Women between 18 and 50 years of age with pain associated with pelvic muscle spasm and endometriosis. Pain must be persistent (lasting for at least 3 months).

Design:

Participants will keep a pain diary and record their pain medication use for a month before the first visit.
Participants will be screened with a physical exam and medical history. Blood and urine samples will be collected. Participants will also answer questions about their pain levels and quality of life.
Participants will receive either botulinum toxin or a placebo (salt water) injection. The injection will be given into the pelvic floor muscles through the vaginal wall. Participants will take a muscle relaxant like Valium and have anesthetic cream put on the vaginal wall before the injection.
After the injection, participants will keep a pain diary for another month.
At a 1-month followup visit, participants will answer questions about their pain. If the pain has not improved, all participants may have a botulinum toxin injection (no placebo) into the pelvic floor muscles as before.
Participants will have followup visits for up to a year after the initial 1-month followup visit.

Full description

Chronic pelvic pain associated with endometriosis is poorly understood. Some women with chronic pelvic pain have muscle spasm of their pelvic muscles. Muscle spasm may be a significant part of pain in women with endometriosis and other types of chronic pelvic pain. Botulinum toxin injection is widely used to treat conditions associated with excessive muscle activity and spasm. Studies of botulinum toxin injected into pelvic muscles of women with pelvic pain have shown a decrease pain and spasm, but too few women have been studied to conclude its effectiveness. We expect to show that botulinum toxin injection in women with pelvic pain will relieve some of their pelvic pain.

Eligible subjects will be otherwise healthy women who have chronic pelvic pain and a history of endometriosis. Subjects will be randomized to either botulinum toxin injection or placebo (salt water) injection. After one month, we will evaluate the presence of the pain and all women will be offered botulinum toxin injection. We will also evaluate the need for reinjection.

Enrollment

30 patients

Sex

Female

Ages

18 to 55 years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

INCLUSION CRITERIA:
Female gender
Age between 18 and 55
History of endometriosis at surgery
Persistent pelvic pain for at least 3 months
Pelvic floor spasm
Negative pregnancy test (in women who have not had a hysterectomy)
Willing to use reliable method of contraception for the month after botulinum toxin injection including oral contraceptives, IUD, and barrier with spermicide.
Willing and able to give informed consent
Willing and able to comply with study requirements

EXCLUSION CRITERIA:

Women with other causes of chronic pelvic pain including infectious, gastrointestinal, psychological disorders, fibromyalgia and chronic fatigue syndrome based on review of medical history within 1 year of first study visit,
Untreated severe cervical dysplasia or other gynecologic condition clinically significant abnormalities on physical or laboratory examinations that require evaluation or treatment or that would make participation unsafe
Hysterectomy and bilateral salpingo-oophorectomy
Pregnancy
Lactation
Allergy to albumen or botulinum toxin
Presence of antibodies to botulinum toxin or loss of response to previous injections for any indication
A known neuromuscular junction disorder such as myasthenia gravis or Eaton-Lambert syndrome
History of urinary or fecal incontinence
Known pelvic prolapse
- Eligibility will be based on a physical exam at NIH at the first study visit, as well as history and available medical records within 1 year before the study visit. Negative test results will be documented to confirm study eligibility. If the Pap and the GC and chlamydia tests were not done outside of the NIH within the previous year, or if documentation of the negative test results is not available, we will await the results of the screening tests done at the NIH before administering the study medication.