• Gopinath Niraj and Sanjay Chaudhri.
• Clinical Research Unit of Pain Medicine.
• Pain Med. 2018 Mar 1; 19 (3): 589-597.

BackgroundUnexplained abdominal pain is a common cause of hospital admission and utilizes significant resource. Current in-patient pain management of acute exacerbation of chronic abdominal pain is primarily directed at pharmacological and psychological management strategies in this group of complex patients. We adopted a novel approach that proved to be both clinically effective and cost-effective.DesignAdult patients admitted to a surgical ward with acute exacerbation of chronic abdominal pain referred to in-patient pain management were prospectively audited over a two-year period at a single tertiary centre.MethodsManagement strategy focused on a somatic source as the predominant pain generator. Patients were offered ultrasound-guided trigger point injection with steroids within 48 hours of referral and were discharged when pain control was achieved. Subsequent care by the pain physician included targeted treatment of somatic component (repeated trigger point injection with steroids or pulsed radiofrequency treatment of trigger points).ResultsWe audited 43 patients referred to the inpatient pain management service over a two-year period. Four patients refused to undergo the diagnostic trigger point injection. Three patients with active visceral disease had a transient response to the injection. Thirty-six patients were diagnosed with abdominal myofascial pain syndrome, and two-thirds of these patients were discharged home within 36 hours of the intervention.ConclusionsAbdominal myofascial pain syndrome is a poorly recognized cause of chronic abdominal pain, especially in patients with a past history of visceral inflammation. The novel strategy resulted in a significant reduction in opioid consumption, length of stay, and readmission rate.

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