Background: Chronic abdominal wall pain
(CAWP) is often undiagnosed and results in
significant health care use as well as patient
suffering. There are two main types: abdominal
myofascial pain syndrome (AMPS) and anterior
cutaneous nerve entrapment syndrome
(ACNES). Although the 2 conditions share clinical
similarities, they have subtly distinct unique
features.
Objectives: To highlight the current practice,
elucidate the characteristics of the 2 types of
CAWP, and direct the spotlight on abdominal
myofascial pain.
Study Design: Prospective case series.
Setting: Tertiary pain medicine clinic in a university
hospital.
Methods: As a part of a prospective audit of
management of chronic abdominal pain, patients
completed brief pain inventory-short form
questionnaires at baseline and at 3 months posttrigger
point treatment.
Results: All 3 patients were misdiagnosed with
ACNES. Patient 1 was attending the emergency
department once every 5 days prior to being correctly
diagnosed with AMPS. Following trigger
point treatment, there was a significant reduction
in emergency department attendance. Patient 2,
with a 10-year history of lower abdominal pain that
resulted in severe disability, was able to mobilize
following trigger point treatment. Patient 3, with
a high opioid use (360 mg per day), was able to
discontinue opioids following ultrasound-guided
trigger point injection with depot steroids.
Limitations: Open label case series in a small
cohort.
Conclusions: AMPS is as common as the various
visceral inflammatory diseases. Lack of awareness,
ignoring its existence, and misdiagnosing it
may not benefit patients with chronic abdominal
pain.
Key words: Chronic abdominal wall pain, abdominal
myofascial pain syndrome, anterior cutaneous
nerve entrapment syndrome, viscerosomatic
convergence
Use of Targeted Transversus Abdominus Plane
Blocks in Pediatric Patients with Anterior
Cutaneous Nerve Entrapment Syndrome
