# High-Density Surface Electromyography Guided Precision Botulinum Neurotoxin Injections to Manage Chronic Pelvic Floor Pain

> **NIH NIH R01** · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · 2024 · $341,988

## Abstract

Abstract
Interstitial cystitis/ bladder pain syndrome (IC/BPS) is one of the most debilitating chronic pelvic pain (CPP)
conditions that negatively impacts the quality of life and sexual activities in 2.7% to 6.5% of women in the US.
Pelvic floor hypertonicity (PFH) is prevalent among patients with CPP, and is present in up to 85% of women
with IC/BPS. PFH is a multifactorial problem that involves impaired relaxation of the pelvic musculature due
to the activation of nociceptors and release of inflammatory chemicals. Current clinical strategies employ
physical therapy interventions to relax the muscle to improve muscle coordination. Alternative therapies that
use oral or intra-vaginal muscle relaxants may be suggested when conservative methods fail. Specifically,
botulinum neurotoxin (BoNT), has received growing interest in managing pelvic pain secondary to PFH. BoNT
inhibits the neuromuscular transmission at neuromuscular junctions, indicated by innervation zones (IZs), by
blocking the acetylcholine release, leading to transient muscle relaxation, and the relief of pain symptoms.
Despite its potency and safety, BoNT can cause dose-dependent adverse effects and is expensive. Studies
have demonstrated that increasing the injection distance by 1 cm from the IZs reduced the effect of BoNT by
46%. It is clinically important to localize in vivo the IZ distributions in the pelvic floor muscles to guide precision
BoNT injections for optimal treatment efficacy with reduced treatment cost.
Our team has successfully developed a novel high-density surface electromyography (HD-sEMG) technique
to 1) reliably and quantitatively assess PFH and 2) accurately image the IZ distributions of hypertonic PFMs,
and has 3) successfully demonstrated the significant improvement in treatment outcome of BoNT injection
with HD-sEMG vs. without HD-sEMG guidance, in managing muscle spasticity. The goal of this proposal is
to develop a personalized, precision BoNT injection approach guided by intra-vaginal HD-sEMG to optimize
the treatment outcome in IC/BPS management. This research represents the first effort to quantitatively and
objectively study the feasibility of using intra-vaginal HD-sEMG for personalized, precision guided BoNT
injections to optimize the diagnosis and treatment of IC/BPS. The proposed technique will serve as an in vivo
pelvic floor phenotyping tool that can be used to deliver personalized injection of BoNT to personalized
injection sites with personalized doses, which will lead to more effective BoNT treatment with reduced
treatment cost (by reducing injection dose). The study will also advance our understanding of the
pathophysiology of PFH, and mechanism of BoNT management, and help establishing an advanced standard
of objective assessment of PFH and BoNT injections.

## Key facts

- **NIH application ID:** 11102726
- **Project number:** 7R01DK133800-03
- **Recipient organization:** UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
- **Principal Investigator:** Yingchun Zhang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $341,988
- **Award type:** 7
- **Project period:** 2024-06-04 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11102726

## Citation

> US National Institutes of Health, RePORTER application 11102726, High-Density Surface Electromyography Guided Precision Botulinum Neurotoxin Injections to Manage Chronic Pelvic Floor Pain (7R01DK133800-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/11102726. Licensed CC0.

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