Management of chronic abdominal wall pain: A one-year

Abstract

Objectives: This study was designed to determine the prevalence of chronic abdominal wall pain (CAWP) in the gastroenterology clinic unit (GCU) and investigated the criteria of CAWP patients. Therapeutic trials to control such annoying problem were investigated. Methods: The study had two stages; the first stage was a cross-sectional analysis of the adult patients who were suffering from chronic abdominal pain. Patients reporting a score value ≥ 10 on the Questionnaire of CAWP in addition to a positive Carnett´s sign were included in this study. Included patients were subjected to study the criteria of CAWP. The second stage was a randomized clinical trial where anti-neuropathic drugs (e.g. pregabalin-carbamazepine-amitriptyline) were used. Results: CAWP was diagnosed in 30.6% of the screened patients. 76% were female. Upper right quadrant pain was reported in 48.1%. Delay in diagnosis was reported to be 9.14±8.9 months. Misdiagnosis as cholecystitis, peptic ulcer disease and irritable bowel syndrome was reported. 94.4 % of treated patients showed a satisfactory response to anti-neuropathic medications. 5.6 % was successfully controlled by local injection. Significant lower Visual Analogue Scale (VAS) was reported after 2 weeks and 1, 2, 3, 4 and 6 months of the treatment plan implementation when comp-ared to the basal value (p. < 0.001). Conclusions: CAWP was identified in 30.6% of the patients complaining of chronic abdominal pain. Multiple physician consultations, delayed diagnosis, mis-diagnosis with subsequent mistreatment were common. While, anti-neuropathic drugs are an effective tool in most cases of CAWP, trigger point injection represents an alternative line of treatment.