Trigger point injections may provide prolonged relief by interfering with transmission of the pain impulse and thus eliminating the positive feedback arc.10 No RCTs specifically looked at chronic pelvic pain and trigger point injections. One small RCT compared trigger point injections in patients with myofascial syndrome with bupiva-caine 0.5 percent, etidocaine 1 percent, or saline. Subjective improvement was noted with the local anesthetic treatment over saline.146[II] Slocumb10[III] studied the response of 122 women with abdominal pelvic pain characterized by dermatome hypersensitivity and trigger points: 89.3 percent reported relief or improvement in pain, such that no further therapy was required over the duration of the study (3-36 months). Further management of myofascial pain is described in Chapter 12, Diagnostic procedures in chronic pain. Botulinum toxin injections were effective in reducing pain in patients with myofascial pain syndrome but the difference in pain between the two modes was not significantly different.147[II]
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