Recognition and Treatment of Abdominal Wall Pain

Abstract

In some patients with abdominal pain, the source of the pain may be the abdominal wall. A simple test is described which allows these patients to be identified and treated with injections of local anaesthetic and steroid. Twenty-six patients were studied, 20 of whom were available for follow-up. Sixteen of these 20 were symptom free or improved at a median follow-up period of 29 months. Failure to recognize abdominal wall pain may lead to unnecessary investigation.

Long-term Follow-up of Trigger Point Injections for Abdominal Wall Pain

“…One of the more widely studied treatments consists of TPI into the most tender spot. There have been a number of case reports and studies looking at short-term relief but there are very few studies that have looked at long-term outcome from these injections (16)(17)(18)(19)(20)(21)(22). The majority of the studies show rates of long-term relief in the 70% to 80% range.…”

Pseudoappendicitis: abdominal pain arising from thoracic spine dysfunction—a forgotten entity and a reminder of an important clinical lesson

“…Subsequently, Wills and Atsatt described five cases of pseudoappendicitis of spinal origin which they cured by injecting the thoracic spine when other treatments failed,8 and Harman and Young successfully treated cases of chronic appendicitis, chronic cholecystitis and renal colic by injecting 1% procaine solution into tender areas of the lower thoracic spine and in the muscles of the abdominal wall, when all other treatments failed 9. More recently, there has been acknowledgement in the literature of chronic non-visceral sources abdominal pain but with no explicit explanation of thoracic spine dysfunction,10 and in other articles hip and/or low back pain symptoms have been found to contribute to abdominal pain,11 and the abdominal wall has also been highlighted as the cause of abdominal pain 12Patient's perspective

Case 1 said ‘Thanks a million for all your help and support, without your expertise and identification of my problem, I probably would not now have my little family’.

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Importance of a Physical Examination for Efficient Differential Diagnosis of Abdominal Pain: Diagnostic Usefulness of Carnett's Test in Psychogenic Abdominal Pain

“…If Carnett's test is positive, pain relief after an accurately placed nerve block or trigger point anesthesia injection can lead to diagnostic therapy. Pain relief with anesthesia injection affords excellent reassurance to the patient when effective (3,12,13). Carnett's test may not be interpretable in patients who cannot adequately comply with leg or head-raising maneuvers.…”