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Trigger point injection as an adjunct to physical therapy is well tolerated and improves symptoms of pelvic floor muscle spasm in approximately 50% of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), according to results from a study published in Translational Andrology and Urology.1
Pelvic floor tenderness may be present in up to 85% of men with CP/CPPS and is typically treated with pelvic floor physical therapy as first-line treatment. Pelvic floor physical therapy is effective even in patients who are refractory to other treatments, improving symptoms in up to 72% of this population. However, the success of pelvic floor physical therapy depends in part on treatment by a physical therapist skilled in this technique, and those practitioners are scarce. In addition, not all patients improve with pelvic floor physical therapy, and some patients who initially respond to therapy may reach a point at which continuing physical therapy no longer results in further improvement.
Trigger point injection, which is commonly used to treat other pain conditions, has been shown to improve symptoms in women with chronic pelvic pain, with efficacy similar to that of physical therapy.2,3 However, data are lacking on the use of trigger point injection in men with pelvic floor muscle spasm.
In the current study, researchers examined the safety and efficacy of pelvic floor trigger point injection for pelvic floor muscle spasm in men with CP/CPPS in a retrospective registry review. A total of 37 patients with CP/CPPPS, who were noncompliant with or refractory to pelvic floor physical therapy, underwent 68 trigger point injections. Nearly half of patients had 1 trigger point injection, 11 had 2 injections, and 10 had 3 injections. A total of 9 patients were also treated with anterior ilioinguinal block. Patients were followed for 3 months or longer.
Trigger point injections significantly reduced the total National Institutes of Health-Chronic Prostatitis Symptom Index (CPSI; range 0-43, with higher scores indicating greater severity), with scores reduced from 28.8 at baseline to 21.8 after treatment (P <.0001).1,4 CPSI score decreased by ≥6 points in 53% of patients treated. In a similar fashion, 35.3% and 29.4% of patients reported significant improvement and some improvement, respectively, by the Global Response Assessment (GRA). Approximately one-third of patients had no change by the GRA, and 1 patient reported worsened symptoms.
All 3 patients who were noncompliant with pelvic floor physical therapy experienced no improvement with trigger point injection. Adverse events included temporary numbness in the lateral thigh in 3 patients and inability to bear weight on one leg for 30 minutes in 1 patient.
Summary and Applicability
Pelvic floor tenderness due to pelvic floor muscle spasm in CP/CPPS can be challenging to treat, and pelvic floor physical therapy is not effective in all patients. In a retrospective registry study, researchers found that trigger point injection, when used in conjunction with pelvic floor physical therapy, had few complications and improved symptoms in half of patients with refractory CP/CPPS.
“Interestingly, there was no improvement in the three patients who were noncompliant with their [pelvic floor physical therapy]. This emphasizes that the injection alone has a temporary effect and must be supplemented by continued stretching and muscle manipulation,” the researchers wrote.
Limitations and Disclosures
Because this study had short follow-up, more studies are needed to determine the long-term efficacy of trigger point injection for pelvic floor muscle spasm in CP/CPPS.
References
- Tadros NN, Shah AB, Shoskes DA. Utility of trigger point injection as an adjunct to physical therapy in men with chronic prostatitis/chronic pelvic pain syndrome. Transl Androl Urol. 2017;6(3):534-537. doi:10.21037/tau.2017.05.36
- Langford CF, Udvari Nagy S, Ghoniem GM. Levator and trigger point injections: An underutilized treatment for chronic pelvic pain. Neurourol Urodyn. 2007;26(1):59-62.
- Zoorob D, South M, Karram M, et al. A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain. Int Urogynecol J. 2015;26(6):845-852. doi:10.1007/s00192-014-2606-4
- Clemens JQ, Calhoun EA, Litwin MS, et al. Rescoring the NIH chronic prostatitis symptom index: nothing new. Prostate Cancer Prostatic Dis. 2009;12(3):285-287. doi:10.1038/pcan.2009.22
