Introduction: Chronic pelvic pain represents a common and disabling disorder. Chronic pelvic pain is non-menstrual related pain for more than 6 months. This entity is difficult to manage because of often unclear origin and weak response treatment. There are other problems associated with this disorder, which can include many organ systems. Modalities of treatment can include nsaids, hormone replacement therapy, anti-depressants, anti-spasticity injections, surgery, and nerve ablation. Here we report a case of chronic pelvic pain highly responsive to a posterior approach botulinum toxin injection to the iliopsoas muscle.

Materials and Methods: 56 y.o. female with a history of left labial pain for 12 years. Patient with additional history significant for low back pain, buttock pain since a fall 12 years ago as well. Patient claims she has severe pelvic muscle spasms most of the day. Patient has done poorly with treatments including anterior approach iliopsoas botulinum toxin injection, opioids and a neurostimulator. Her physical examination is positive for left iliopsoas generated pain and muscle spasms. For the procedure patient was placed in the prone position with the fluoroscopy alignment onto left L4 transverse process. A 5” 22 gauge spinal needle was passed to spinous process periosteum level and marched off inferiorly and advanced 1.5cm in depth. The medication was injected and the needle track was cleared using lidocaine. Mild discomfort was noted during the procedure and subsequent spasms for approximately 20 minutes after the procedure.

Results: The patient experienced moderate pain relief, a decrease in more than 50% of her pain level, and the relief lasted for 4 months.

Conclusions: We report here a case of a female with poor response to an anterior approach and a quite significant response to a posterior retroperitoneal approach to the iliopsoas muscle for chemo-denervation and spasm relief.