Background: Abdominal myofascial pain syndrome is an important cause of refractory chronic
abdominal pain. It causes severe functional impairment resulting in significant patient distress and
substantial health care costs, and it can be a challenge to treat. Opioid consumption is a recognized
challenge in this cohort.
Design: We conducted a prospective longitudinal audit over a 6-year period.
Setting: The study was conducted at a tertiary pain medicine clinic in a university teaching
hospital.
Methods: Over a 6-year period, 234 patients diagnosed with chronic abdominal pain secondary
to abdominal myofascial pain syndrome were included in a structured management pathway.
Long-term outcomes were prospectively audited at a tertiary-care university hospital. Patients
who completed a minimum of 12 months in the pathway were included. The main outcome
was reduction in opioid consumption. Treatment outcomes included treatment failure, number of
patients with clinically significant pain relief, durable pain relief, and long-term pain relief. Other
outcomes included patient satisfaction and success in maintaining gainful employment.
Results: Two hundred seven patients completed a minimum of 12 months of follow-up. Seventyeight percent (162 of 207) were on opioids at presentation. There was significant reduction in
opioid consumption at ≥ 12 months’ follow-up. Among patients who underwent interventional
management, clinically significant relief was reported in 31 patients (31 of 180, 17%), durable
relief in 71 patients (71 of 180, 40%) and long-term relief lasting 12 months in 23 patients (23 of
180, 13%). Twenty-six patients (26 of 180, 15%) reported cure from symptoms. The treatment
failure rate was 15%.
Limitations: This was an open-label study that took place at a single center.
Conclusion: The authors present the first prospective practice-based evidence report on the
long-term outcomes in patients diagnosed with abdominal myofascial pain syndrome. There was
significant reduction in opioid consumption at 12 months and over two-thirds of patients reported
significant durable relief on long-term follow-up. The authors present their recommendation for
managing this complex group of patients.
Keywords: Abdominal myofascial pain syndrome, abdominal plane blocks, chronic abdominal
wall pain, opioid reduction, quadratus lumborum block, TAP block, viscerosomatic convergence
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