Use of botulinum toxin for chronic pelvic pain

摘要

Chronic pelvic pain (CPP) is a significant healthcare problem with estimated prevalence of 2.1-24 of the female population worldwide, depending on the definition 1. It is defined as continuous or recurrent pain in the lower abdomen or the pelvis lasting at least 6 months, not related to pregnancy, and sufficiently severe to interfere with the habitual activities of the patient. The etiology of pelvic pain is poorly understood and it is often the result of a complex interaction between the gastrointestinal, urinary, gynecologic, musculoskeletal, and neurologic and endocrine systems and is also influenced by psychological and socio-cultural factors 2. The social, psychological and economic impact of CPP is high. Compared with women who have no pelvic pain, women with any type of pelvic pain were more likely to report having some form of sexual difficulty for at least a month during the previous 12 months 3. Estimated direct medical costs for outpatient visits for chronic pelvic pain for the US population of women aged 18-50 years are US$881.5 million per year. This medical cost is compounded by the economic cost to the women as reported in a study of 548 employed respondents, 15 reported time lost from paid work and 45 reported reduced work productivity 4.