Editor-in-Chief: Kenneth D. Candido, MD

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  1. IPM 2019;3;91-97 Misdiagnosing Abdominal Myofascial Pain Syndrome as Anterior Cutaneous Nerve Entrapment Syndrome: Are We Failing Patients with Nonspecific Abdominal Pain?
    Case Series
    G Niraj, MD, FRCA, Mahesh Kodivalasa, FFPMRCA, and Sachin Alva, FRCA.

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