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Chronic Abdominal Wall Pain: Diagnosis and Interventional Treatment

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Chronic Abdominal Pain

Abstract

Chronic abdominal wall pain is not uncommon and can be confused with visceral pain leading to inappropriate management. In this chapter, we will review the anatomy of the anterior abdominal wall, the differential diagnosis, as well as the management of various abdominal wall pain disorders.

To reach an appropriate diagnosis, it is crucial to obtain a detailed history and examination, and to know when to implement various diagnostic tests including—the now popular—transversus abdominis plane (TAP) block.

Post-inguinal herniorrhaphy pain and anterior cutaneous nerve entrapment syndrome will be discussed in details.

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References

  1. Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: a frequently overlooked problem. Am J Gastroenterol. 2002;97:824–30.

    PubMed  Google Scholar 

  2. Costanza CD, Longstreth GF, Liu AL. Chronic abdominal wall pain: clinical features, health care costs and long term outcome. Clin Gastroenterol Hepatol. 2004;2:394–9.

    Article  Google Scholar 

  3. Langdon DE. Abdominal wall pain will be missed until examinations change! Am J Gastroenterol. 1998;2002:3207–8.

    Google Scholar 

  4. Applegate WV. Abdominal cutaneous nerve entrapment syndrome. Surgery. 1972;71:118–24.

    CAS  PubMed  Google Scholar 

  5. Sharpstone D, Colin-Jones DG. Chronic, non-visceral abdominal pain. Gut. 1994;35:833–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Carnett JB. Intercostal neuralgia as a cause of abdominal pain and tenderness. Surg Gynecol Obstet. 1926;42:625–32.

    Google Scholar 

  7. Straus JL, von Ammon Cavanaugh S. Placebo effects. Issues for clinical practice in psychiatry and medicine. Psychosomatics. 1996;37:315–26.

    Article  CAS  PubMed  Google Scholar 

  8. Gray DWR, Seabrook G, Dixon JM, et al. Is abdominal wall tenderness a useful sign in the diagnosis of non-specific abdominal pain? Ann R Coll Surg Engl. 1988;70:233–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  9. Conwell DL, Vargo JJ, Zuccaro G, et al. Role of differential neuroaxial blockade in the evaluation and management of pain in chronic pancreatitis. Am J Gastroenterol. 2001;96:431–6.

    Article  CAS  PubMed  Google Scholar 

  10. Bradley EL, Reynhout JA, Peer GL. Thorascopic splanchnicectomy for a small duct chronic pancreatitis: case selection by differential epidural anesthesia. J Gastrointest Surg. 1998;2:88–94.

    Article  PubMed  Google Scholar 

  11. Rizk MK, Tolba R, Kapural L, Mitchell J, Lopez R, Mahboobi R, Vrooman B, Mekhail N. Differential epidural block predicts the success of visceral block in patients with chronic visceral abdominal pain. Pain Pract. 2012;12:595–601.

    Article  PubMed  Google Scholar 

  12. McCollum DE, Stephen CR. The use of graduated spinal anesthesia in the differential diagnosis of pain of the back and lower extremities. South Med J. 1964;57:410–6.

    Article  CAS  PubMed  Google Scholar 

  13. Soilman LM, Narouze S. Ultrasound-guided transversus abdominus plan block for the management of abdominal pain: an alternative to differential epidural block. Tech Reg Anesth Pain Manag. 2009;13:117–20.

    Article  Google Scholar 

  14. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56:1024–6.

    Article  CAS  PubMed  Google Scholar 

  15. McDonnell JG, O’Donnell BD, Curley G, et al. The analgesic efficacy of transverses abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104:193–7.

    Article  PubMed  Google Scholar 

  16. Rozen WM, Tran TM, Ashton MW, et al. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat. 2008;21:325–33.

    Article  CAS  PubMed  Google Scholar 

  17. Guirguis MN, Abd-Elsayed AA, Girgis G, Soliman LM. Ultrasound-guided transversus abdominis plane catheter for chronic abdominal pain. Pain Pract. 2013;13:235–8.

    Article  PubMed  Google Scholar 

  18. Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95:69–76.

    Article  CAS  PubMed  Google Scholar 

  19. Aasvang EK, Brandsborg B, Christensen B, Jensen TS, Kehlet H. Neurophysiological characterization of postherniotomy pain. Pain. 2008;137:173–81.

    Article  PubMed  Google Scholar 

  20. Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, Bittner R, Kehlet H. Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010;112:957–69.

    Article  PubMed  Google Scholar 

  21. Deysine M, Deysine GR, Reed Jr WP. Groin pain in the absence of hernia: a new syndrome. Hernia. 2002;6:64–7.

    Article  CAS  PubMed  Google Scholar 

  22. Loos MJ, Verhagen T, Scheltinga MR, Roumen RM. A randomized controlled trial of injection therapy versus neurectomy for post-herniorrhaphy inguinal neuralgia: rationale and study design. Hernia. 2010;14:593–7.

    Article  CAS  PubMed  Google Scholar 

  23. Thomassen I, van Suijlekom JA, van de Gaag A, Ponten JE, Nienhuijs SW. Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for chronic pain after inguinal hernia repair. Hernia. 2013;17:329–32.

    Article  CAS  PubMed  Google Scholar 

  24. Bischoff JM, Koscielniak-Nielsen ZJ, Kehlet H, Werner MU. Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial. Anesth Analg. 2012;114(6):1323–9.

    Article  PubMed  Google Scholar 

  25. Loos MJ, Scheltinga MR, Roumen RM. Tailored neurectomy for treatment of postherniorrhaphy inguinal neuralgia. Surgery. 2010;147:275–81.

    Article  PubMed  Google Scholar 

  26. Aasvang E, Kehlet H. Surgical management of chronic pain after inguinal hernia repair. Br J Surg. 2005;92:795–801.

    Article  CAS  PubMed  Google Scholar 

  27. Eichenberger U, Greher M, Kirchmair L, Curatolo M, Moriggl B. Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection. Br J Anaesth. 2006;97:238–43.

    Article  CAS  PubMed  Google Scholar 

  28. Peng P, Narouze S. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part I nonaxial structures. Reg Anesth Pain Med. 2009;34:458–74.

    Article  PubMed  Google Scholar 

  29. Fanelli RD, DiSiena MR, Lui FY, Gersin KS. Cryoanalgesic ablation for the treatment of chronic postherniorrhaphy neuropathic pain. Surg Endosc. 2003;17:196–200.

    Article  CAS  PubMed  Google Scholar 

  30. Bower S, Moore BB, Weiss SM. Neuralgia after inguinal hernia repair. Am Surg. 1996;62:664–7.

    CAS  PubMed  Google Scholar 

  31. Cohen SP, Foster A. Pulsed radiofrequency as a treatment for groin pain and orchialgia. Urology. 2003;61:645.

    Article  PubMed  Google Scholar 

  32. Mitra R, Zeighami A, Mackey S. Pulsed radiofrequency for the treatment of chronic ilioinguinal neuropathy. Hernia. 2007;11:369–71.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Amid PK. Causes, prevention, and surgical management of postherniorrhaphy neuropathic inguidynia: triple neurectomy with proximal end implantation. Hernia. 2004;8:343–9.

    Article  CAS  PubMed  Google Scholar 

  34. Aasvang EK, Kehlet H. The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg. 2009;249:327–34.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Center for Pain Medicine, Western Reserve Hospital, 1900 23rd Street, Cuyahoga Falls, OH, 44333, USA

    Samer Narouze M.D., Ph.D.

Authors
  1. Samer Narouze M.D., Ph.D.
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Correspondence to Samer Narouze M.D., Ph.D. .

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Editors and Affiliations

  1. Medical Director, Carolinas Pain Institute and Clinical Research Center, Professor of Anesthesiology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina, USA

    Leonardo Kapural

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Narouze, S. (2015). Chronic Abdominal Wall Pain: Diagnosis and Interventional Treatment. In: Kapural, L. (eds) Chronic Abdominal Pain. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1992-5_18

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  • DOI: https://doi.org/10.1007/978-1-4939-1992-5_18

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1991-8

  • Online ISBN: 978-1-4939-1992-5

  • eBook Packages: MedicineMedicine (R0)

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