Chronic abdominal wall pain
- George W Meyer, MD, FACP, MACG
George W Meyer, MD, FACP, MACG
- Clinical Professor of Medicine
- University of California Davis, School of Medicine
Chronic pain emanating from the abdominal wall is frequently unrecognized or confused with visceral pain, often leading to extensive diagnostic testing before an accurate diagnosis is achieved [1-7]. Once considered, the diagnosis can often be established with a history and physical examination. Treatment with a local anesthetic agent is effective for most patients, and can further help to confirm the diagnosis.
This topic review will focus on the diagnosis and treatment of abdominal wall pain. An approach to patients presenting with abdominal pain is presented separately. (See "Differential diagnosis of abdominal pain in adults".)
The exact prevalence of abdominal wall pain is unknown. Abdominal wall pain has been diagnosed in 10 to 90 percent of patients with abdominal pain of unknown cause in various series based upon the patient cohort . In one study, 5 to 10 percent of patients referred to specialist practices in gastroenterology had a diagnosis of chronic abdominal wall pain. In another study, 20 percent of patients admitted to a surgical department for abdominal pain had abdominal wall pain .
Women appear to be four times more likely to have chronic abdominal wall pain than men. The peak incidence is between the ages of 30 to 50 years, although cases have been reported in children and the elderly.
While many conditions can cause chronic pain in the abdomen (eg, radicular pain radiating from T7 to T12 lesions [such as are caused by Herpes zoster infection] or referred pain from abdominal or thoracic sources), the term "chronic abdominal wall pain" usually refers to anterior cutaneous nerve entrapment syndrome (ACNES), one of the most common causes of this condition. The following discussion will focus on this condition, while the other causes are discussed separately. (See "Differential diagnosis of abdominal pain in adults".)
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- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Abdominal wall hernias
- Surgical scars
- Abdominal wall endometriosis
- Thoracic nerve radiculopathy
- Thoracic disc syndrome
- Pain generated from the ribcage and chest wall
- Rectus sheath hematoma
- Slipping rib syndrome
- Ribs on pelvis syndrome
- Physical therapy
- Injection therapy
- SUMMARY AND RECOMMENDATIONS