Abstract：
Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A (BTX-A) may represent a promising therapeutic strategy for these patients. The aim of this systematic review was to investigate the role of BTX-A in CPPS treatment.
We reviewed the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed from English language articles published between January 2000 and October 2021. The primary outcome was to evaluate pain improvement in CPPS after BTX-A treatment. Pooled meta-analysis of the included studies, considering the effect of BTX-A on pain evaluated at last available follow-up compared to baseline values, was performed together with meta-regression analysis.
After screening 1001 records, 18 full-text manuscripts were selected, comprising 13 randomized clinical trials and five comparative studies. They covered overall 896 patients of both sexes and several subtype of CPPS (interstitial cystitis/bladder pain syndrome, chronic prostatitis/prostate pain syndrome, chronic scrotal pain, gynecological pelvic pain, myofascial pelvic pain). The clinical and methodological heterogeneity of studies included makes it difficult to do an overall estimation of the real effect of BTX-A on pain and other functional outcomes of various CPPS subtypes. However, considering pooled meta-analysis results, a benefit in pain relief was showed for BTX-A-treated patients both in the overall studies populations and in the overall cohorts of patients with CPP due to bladder, prostate, and gynecological origin.
BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.
We reviewed the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed from English language articles published between January 2000 and October 2021. The primary outcome was to evaluate pain improvement in CPPS after BTX-A treatment. Pooled meta-analysis of the included studies, considering the effect of BTX-A on pain evaluated at last available follow-up compared to baseline values, was performed together with meta-regression analysis.
After screening 1001 records, 18 full-text manuscripts were selected, comprising 13 randomized clinical trials and five comparative studies. They covered overall 896 patients of both sexes and several subtype of CPPS (interstitial cystitis/bladder pain syndrome, chronic prostatitis/prostate pain syndrome, chronic scrotal pain, gynecological pelvic pain, myofascial pelvic pain). The clinical and methodological heterogeneity of studies included makes it difficult to do an overall estimation of the real effect of BTX-A on pain and other functional outcomes of various CPPS subtypes. However, considering pooled meta-analysis results, a benefit in pain relief was showed for BTX-A-treated patients both in the overall studies populations and in the overall cohorts of patients with CPP due to bladder, prostate, and gynecological origin.
BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.
摘要：
慢性盆腔疼痛综合征（CPPS）患者的疼痛管理具有挑战性，因为疼痛通常是常规治疗的难治性。肉毒杆菌毒素A（BTX-A）可能代表了这些患者的有希望的治疗策略。本系统综述旨在探讨BTX-A在CPPS治疗中的作用。
我们回顾了评估BTX-A治疗CPPS的前瞻性研究的文献。在PubMed中进行全面搜索，Scopus,WebofScience,Cochrane中央对照试验注册数据库是根据2000年1月至2021年10月之间发表的英语文章进行的。主要结果是评估BTX-A治疗后CPPS的疼痛改善。纳入研究的汇总荟萃分析，考虑到BTX-A对疼痛的影响，与基线值相比，与荟萃回归分析一起进行。
筛选1001条记录后，选择了18份全文手稿，包括13项随机临床试验和5项比较研究。他们涵盖了896名男女患者和几种CPPS亚型（间质性膀胱炎/膀胱疼痛综合征，慢性前列腺炎/前列腺疼痛综合征，慢性阴囊疼痛，妇科盆腔疼痛，肌筋膜盆腔疼痛）。包括研究的临床和方法学异质性使得很难对BTX-A对各种CPPS亚型的疼痛和其他功能结果的实际影响进行总体评估。然而,考虑到汇总的荟萃分析结果，在整体研究人群和膀胱引起的CPP患者的整体队列中，BTX-A治疗的患者均显示出缓解疼痛的益处。前列腺,和妇科起源。
BTX-A可能是一些特定CPPS亚型的有效治疗。需要更高水平的研究来评估BTX-A的疗效和安全性，并为其在CPPS管理中的使用提供客观指征。
我们回顾了评估BTX-A治疗CPPS的前瞻性研究的文献。在PubMed中进行全面搜索，Scopus,WebofScience,Cochrane中央对照试验注册数据库是根据2000年1月至2021年10月之间发表的英语文章进行的。主要结果是评估BTX-A治疗后CPPS的疼痛改善。纳入研究的汇总荟萃分析，考虑到BTX-A对疼痛的影响，与基线值相比，与荟萃回归分析一起进行。
筛选1001条记录后，选择了18份全文手稿，包括13项随机临床试验和5项比较研究。他们涵盖了896名男女患者和几种CPPS亚型（间质性膀胱炎/膀胱疼痛综合征，慢性前列腺炎/前列腺疼痛综合征，慢性阴囊疼痛，妇科盆腔疼痛，肌筋膜盆腔疼痛）。包括研究的临床和方法学异质性使得很难对BTX-A对各种CPPS亚型的疼痛和其他功能结果的实际影响进行总体评估。然而,考虑到汇总的荟萃分析结果，在整体研究人群和膀胱引起的CPP患者的整体队列中，BTX-A治疗的患者均显示出缓解疼痛的益处。前列腺,和妇科起源。
BTX-A可能是一些特定CPPS亚型的有效治疗。需要更高水平的研究来评估BTX-A的疗效和安全性，并为其在CPPS管理中的使用提供客观指征。
