Resident Physician Walter Reed National Military Medical Center Bethesda, MD
Caleb Hudspath, DO1, Jeffrey Laczek, MD1, Manish Singla, MD2; 1Walter Reed National Military Medical Center, Bethesda, MD; 2Walter Reed National Military Medical Center, Washington, DC
Introduction: Abdominal wall pain is a common diagnosis seen in 30% in patient’s concomitantly presenting with abdominal pain. Often patients have unrevealing imaging, serum, and endoscopic evaluations. A trigger point injection (TPI) at the point of maximal tenderness using a local anesthetic in conjunction with a positive Carnett’s sign on physical exam can be used as a diagnostic and therapeutic test for abdominal wall pain. Methods: This study is a retrospective review of patients who had a TPI in the Walter Reed National Military Medical Center gastroenterology clinic. Eligible patients were adult ( > 17 years of age) TRICARE beneficiaries seen in our clinic between June 2015 and January 2020. We extracted demographic data (race, age, gender), pain scores (0-10) on exam, acute results following TPI, and pain scores at follow up visit. We additionally collected data to include previous imaging and endoscopic studies prior to TPI. Results: We identified 57 patients who had a for abdominal wall pain with an average age of 47.4 ± 15.8. Average BMI was 28.9 ± 5.0, 30 were Caucasian and 37 were female. Prior imaging included 2.7 ± 2.4 abdominal computed tomography scans and 0.5 ± 0.7 abdominal magnetic resonance imaging studies. Prior endoscopic evaluation include 0.8 ± 1.0 upper endoscopies and 1.0 ± 1.3 colonoscopies. In all patients no adverse reactions were identified. In 47 patients with an initial pain score; mean pain score was 4.9 ± 2.4. Of those 47 patient, 45 patient with a follow up visit showed a statistically significant decrease in pain score (2.7 ± 2.4, p < 0.001). One-third of those patients reported a pain score of 0. Age, BMI, and gender were not associated with differences in pain score. Patients with prior abdominal surgery had lower follow up pain scores. Although not statistically significant, there was a trend that patients on antidepressants show a larger decrease in follow up pain scores than those who were not. Discussion: Patients with abdominal wall pain are often mistaken for having functional pain syndromes which frequently co-exist with mood disorders. Early treatment of abdominal wall pain with TPI can prevent unnecessary endoscopic, serologic, and imaging work up while providing patients immediate relief in the office. Few studies have examined the efficacy of TPI and abdominal wall pain. Our study demonstrates universal pain relief immediately after TPI and a statistically significant decrease in follow up pain scores while showing the overall safety of this procedure.
Disclosures: Caleb Hudspath indicated no relevant financial relationships. Jeffrey Laczek indicated no relevant financial relationships. Manish Singla indicated no relevant financial relationships.