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Chronic Abdominal Wall Pain: A Common Yet Overlooked Etiology of Chronic Abdominal Pain

      Abstract

      Chronic abdominal wall pain is a common, yet often overlooked, cause of chronic abdominal pain in both the outpatient and inpatient settings. This disorder most commonly affects middle-aged adults and is more prevalent in women than in men. In chronic abdominal wall pain, the pain occurs due to entrapment of the cutaneous branches of the sensory nerves that supply the abdominal wall. Although the diagnosis of chronic abdominal wall pain can be made using patient history, physical examination, and response to a trigger point injection, patients often undergo extensive and exhaustive laboratory, imaging, and procedural work-up before being diagnosed with this condition, given it is often overlooked. Carnett’s sign is a specialized physical examination technique that can help support the fact that the abdominal pain originates from the abdominal wall rather than from the abdominal viscera. The mainstay of treatment consists of reassurance, activity modification, over-the-counter analgesic agent, and trigger point injection. In rare cases, treatment with chemical neurolysis or surgical neurectomy may be required.

      Abbreviations and Acronyms:

      CAP ( chronic abdominal pain), CAWP ( chronic abdominal wall pain), TPI ( trigger point injection)
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      Linked Article

      • Chronic and Complex Myofascial Pain Syndromes in Chronic Abdominal Wall Pain
        Mayo Clinic ProceedingsVol. 94Issue 5
        • In Brief
          We appreciated reading the recent article by Kamboj and colleagues, entitled Chronic Abdominal Wall Pain: A Common Yet Overlooked Etiology of Chronic Abdominal Pain.1 We were impressed by the emphasis on a careful physician examination and the description of Carnett's sign. Overlooked, however, was a more thorough discussion of the role of myofascial pain as the most common etiology of abdominal wall pain. Our experience has been that myofascial pain involving the rectus abdominis, obliques, and transversus abdominis is a very common cause of previously undiagnosed chronic, distressing abdominal pain, which frequently involved extensive and costly imaging and referrals.
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      • In Reply: Chronic and Complex Myofascial Pain Syndromes in Chronic Abdominal Wall Pain
        Mayo Clinic ProceedingsVol. 94Issue 5
        • In Brief
          We appreciate the Letter to the Editor by Comerci and colleagues regarding our manuscript, Chronic Abdominal Wall Pain: A Common Yet Overlooked Etiology of Chronic Abdominal Pain.1 We believe that this provides us with an opportunity to further discuss the complex topics of chronic abdominal wall pain (CAWP) and myofascial pain. Although our Concise Review on CAWP was expansive, this format did not allow for a detailed discussion on what is known of its pathophysiology.
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