Mindfulness in Facilitating Pelvic Floor Botulinum Toxin Injection in Women with Chronic Pelvic Pain

TL;DR

Mindfulness sessions before and after botulinum toxin injections can reduce pain and anxiety in women with chronic pelvic pain.

Contribution

This study introduces the use of brief, guided mindfulness to improve tolerability of pelvic floor botulinum toxin injections.

Findings

Mindfulness reduced anxiety before injections by a median of 3.3/10.

Post-injection mindfulness reduced pain by a median of 3/10.

Dysphoria improved by a median of 3/10 after mindfulness sessions.

Abstract

Botulinum toxin (BoNT) injection can safely be done as an office-based procedure, but can be painful itself, especially when injecting pelvic floor muscles to treat chronic pelvic pain (CPP). Mindfulness interventions may reduce procedure-associated acute anxiety and pain. We applied mindfulness techniques to increase the tolerability of office-based pelvic floor BoNT injections in women with CPP. Women enrolled in a clinical trial of BoNT for endometriosis-associated CPP were offered a brief, guided mindfulness session before and/or after transvaginal injection. Anxiety, pain, and dysphoria were rated on a 0–10 numerical rating scale (NRS) before and after each mindfulness session. Eight women underwent mindfulness sessions. Five participants had a session before and two after the transvaginal injection. One participant had two sessions: one before and one after separate injections. All six women completing a session prior to injection had at least moderate anxiety, which lessened after the mindfulness session (median NRS change: −3.3/10). All three women reporting injection-associated pain experienced less intense pain following the post-injection session (median NRS change: −3/10). Three women experiencing dysphoria improved after the session (median NRS change: −3/10). A brief, guided mindfulness session may lessen acute pain, anxiety, and dysphoria associated with office-based transvaginal BoNT injection.

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