A Shared Decision Approach to Chronic Abdominal Pain Based on Cine-MRI: A Prospective Cohort Study

Abstract

We demonstrate long-term pain relief in two-thirds of patients with chronic pain likely caused by adhesions, using cine-MRI and a shared decision-making process. Long-term improvement of pain was achieved in 80% of patients who underwent surgery with concurrent application of an anti-adhesion barrier.

A Randomized Controlled Trial of Thermo-Sensitive Sol–Gel Anti-Adhesion Agent after Gynecologic Surgery

“…Recently, cine-magnetic resonance imaging (cine-MRI) was also proposed as a useful imaging modality to identify patients with adhesions [ 20 , 21 ]. This non-invasive modality covers the whole abdomen and can locate adhesions.…”

“…This non-invasive modality covers the whole abdomen and can locate adhesions. In a prospective cohort study including patients with a history of abdominal surgery and chronic abdominal pain, a decision-making process based on cine-MRI was effective in triaging the patients to operative or conservative treatment [ 21 ]. Therefore, cine-MRI might be an alternative to ultrasonography in the assessment of postoperative adhesion formation.…”

“…However, because of its invasive nature, this method raises ethical issues and is difficult to use in real-world clinical practice. Instead, non-invasive imaging modalities might be alternative options [20]. Previously, our research team validated the diagnostic performance of the ultrasound-based visceral slide test in a prospective cohort of 144 patients scheduled to undergo benign gynecologic surgeries [11].…”

Abdominal hernias and adhesions

“…In addition, the macrophage polarization is described as a spectrum rather than a black and white differentiation. [54][55][56] This may cause heterogeneity in the qPCR data and might limit the ability to reach a statistical difference. This might also be an argument for a larger sample size than calculated for this experiment to reach adequate power.…”

“…It has shown promising results, regarding detecting adhesions non-invasively and it might be possible to find a correlation between adhesions and abdominal pain, when locations of both correspond. 55,56 Other tools to improve knowledge about the burden of adhesions include national and international databases. In these databases much information, including patient characteristics and data on adhesion-related complications, can be collected.…”