Chronic Abdominal Wall Pain Relieved by Sphenopalatine Ganglion Block

Abstract

Background: Chronic Abdominal Wall Pain is a poorly recognized, debilitating, clinical problem that is often difficult to treat. Few clinical trials are available in regards to management of this condition. Injection of local anesthesia in combination with steroids provides relief for some patients, and when pain persists despite these treatments, neurectomy is an option. We report the first case of a transnasal sphenopalatine ganglion block that repeatedly provided greater than 80% pain relief for a patient suffering from intractable Chronic Abdominal Wall Pain. Case Presentation: A 28-year-old female with Crohn's disease and asthma presented with intractable chronic abdominal wall pain after several abdominal surgeries. The patient reported 1.5 years of “very severe,” constant, left upper quadrant abdominal pain that was exacerbated by all physical activity and was significantly affecting her quality of life. Imaging did not demonstrate any pathologic abnormality. Physical/occupational therapy, muscle relaxants, selective serotonin reuptake inhibitors, transcutaneous electrical nerve stimulation, trigger point injections, transversus abdominis plane block, and surgery provided minimal relief. Considering that the sphenopalatine ganglion block (SPGB) has previously been shown to relieve pain of various etiologies, we offered it to this patient. Long cotton-tips were soaked in viscous Lidocaine 2% and were advanced, atraumatically, into each nasal sinus until gentle resistance was met, and left in place for a total of 15 minutes, while the patient was supine. This process was repeated two more times, for a total of 45 minutes. After the first SPGB session, the patient, for the first time, had 80% pain relief that lasted for 3 weeks, with significant improvement in her daily function. Since then, the patient has been receiving this block monthly and each time experiencing the same effect, with sometimes even more than 80% pain relief. The patient reports that this is the only treatment that has so far provided her significant benefit. Discussion: Chronic Abdominal Wall Pain is often difficult to manage with physical/occupational therapy, analgesic medications, and invasive procedures. This case report demonstrates that the lidocaine sphenopalatine ganglion block could be a simple, safe, non-expensive, and non-invasive treatment option for those affected by chronic abdominal wall pain.