# 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.

## Key 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.