Outcomes of Ultrasound-Guided Trigger Point Injection for Abdominal Wall Pain

Mhd Firas Alnahhas, Shawn C. Oxentenko, G. Richard Locke, Stephanie Hansel, Cathy D. Schleck, Alan R. Zinsmeister, Gianrico Farrugia, Madhusudan Grover

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Abdominal wall pain (AWP) is an important cause of chronic abdominal pain. History and physical examination are critical to the diagnosis of AWP. Trigger point injection (TPI) using either a steroid or a local anesthetic or a combination of both is often used to treat AWP. Aim: To determine the efficacy of ultrasound-guided TPI and to determine the predictors of a successful response. Methods: Patients who received ultrasound-guided TPI between July 2010 and June 2011 were surveyed. The primary outcome was determined using the Treatment Efficacy Questionnaire (TEQ). Electronic medical records were reviewed to determine patient, pain and TPI characteristics. Linear regression was used to determine the predictors of a successful response on the TEQ. Results: Right upper quadrant was the most common site of AWP, and the median pain duration was 12 months. Pain was rated as >8 (1–10 scale) by 57 % and 30 % described it as an ache. Narcotic use was reported in 38 %, and 73 % had a history of at least one abdominal surgery. Forty-four of the 120 (37 %) patients met the criteria for responder on the TEQ. Compared to before treatment, 36 % reported being “significantly better” and 22 % “slightly better.” Multiple linear regression analysis showed that higher somatization negatively predicted response. None of the other historical, examination or TPI characteristics were associated with response to the TPI. Conclusion: TPI can provide significant, long-term symptom relief in a third of patients with chronic abdominal pain attributed to AWP. Somatization was inversely related to the treatment success.

Original languageEnglish (US)
Pages (from-to)572-577
Number of pages6
JournalDigestive Diseases and Sciences
Volume61
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Trigger Points
Abdominal Wall
Abdominal Pain
Injections
Pain
Chronic Pain
Linear Models
Electronic Health Records
Narcotics
Local Anesthetics
Physical Examination
History
Steroids
Regression Analysis
Therapeutics

Keywords

  • Abdominal wall pain
  • Chronic abdominal pain
  • Injection
  • Ultrasound

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology
  • Medicine(all)

Cite this

Alnahhas, M. F., Oxentenko, S. C., Locke, G. R., Hansel, S., Schleck, C. D., Zinsmeister, A. R., ... Grover, M. (2016). Outcomes of Ultrasound-Guided Trigger Point Injection for Abdominal Wall Pain. Digestive Diseases and Sciences, 61(2), 572-577. https://doi.org/10.1007/s10620-015-3857-8

Outcomes of Ultrasound-Guided Trigger Point Injection for Abdominal Wall Pain. / Alnahhas, Mhd Firas; Oxentenko, Shawn C.; Locke, G. Richard; Hansel, Stephanie; Schleck, Cathy D.; Zinsmeister, Alan R.; Farrugia, Gianrico; Grover, Madhusudan.

In: Digestive Diseases and Sciences, Vol. 61, No. 2, 01.02.2016, p. 572-577.

Research output: Contribution to journalArticle

Alnahhas, MF, Oxentenko, SC, Locke, GR, Hansel, S, Schleck, CD, Zinsmeister, AR, Farrugia, G & Grover, M 2016, 'Outcomes of Ultrasound-Guided Trigger Point Injection for Abdominal Wall Pain', Digestive Diseases and Sciences, vol. 61, no. 2, pp. 572-577. https://doi.org/10.1007/s10620-015-3857-8
Alnahhas MF, Oxentenko SC, Locke GR, Hansel S, Schleck CD, Zinsmeister AR et al. Outcomes of Ultrasound-Guided Trigger Point Injection for Abdominal Wall Pain. Digestive Diseases and Sciences. 2016 Feb 1;61(2):572-577. https://doi.org/10.1007/s10620-015-3857-8
Alnahhas, Mhd Firas ; Oxentenko, Shawn C. ; Locke, G. Richard ; Hansel, Stephanie ; Schleck, Cathy D. ; Zinsmeister, Alan R. ; Farrugia, Gianrico ; Grover, Madhusudan. / Outcomes of Ultrasound-Guided Trigger Point Injection for Abdominal Wall Pain. In: Digestive Diseases and Sciences. 2016 ; Vol. 61, No. 2. pp. 572-577.
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abstract = "Background: Abdominal wall pain (AWP) is an important cause of chronic abdominal pain. History and physical examination are critical to the diagnosis of AWP. Trigger point injection (TPI) using either a steroid or a local anesthetic or a combination of both is often used to treat AWP. Aim: To determine the efficacy of ultrasound-guided TPI and to determine the predictors of a successful response. Methods: Patients who received ultrasound-guided TPI between July 2010 and June 2011 were surveyed. The primary outcome was determined using the Treatment Efficacy Questionnaire (TEQ). Electronic medical records were reviewed to determine patient, pain and TPI characteristics. Linear regression was used to determine the predictors of a successful response on the TEQ. Results: Right upper quadrant was the most common site of AWP, and the median pain duration was 12 months. Pain was rated as >8 (1–10 scale) by 57 {\%} and 30 {\%} described it as an ache. Narcotic use was reported in 38 {\%}, and 73 {\%} had a history of at least one abdominal surgery. Forty-four of the 120 (37 {\%}) patients met the criteria for responder on the TEQ. Compared to before treatment, 36 {\%} reported being “significantly better” and 22 {\%} “slightly better.” Multiple linear regression analysis showed that higher somatization negatively predicted response. None of the other historical, examination or TPI characteristics were associated with response to the TPI. Conclusion: TPI can provide significant, long-term symptom relief in a third of patients with chronic abdominal pain attributed to AWP. Somatization was inversely related to the treatment success.",
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