title: Chronic abdominal wall pain. Diagnostic validity and costs.
abstract: Chronic abdominal wall pain (CAWP) is common and frequently mistaken for visceral pain. We determined the stability of this diagnosis with Main Outcome Measures of: (a) change of pain intensity after local anesthetic-corticosteroid injection, (b) pain relief after three or more months follow-up, and (c) costs of diagnostic procedures for visceral causes of abdominal pain in patients with confirmed CAWP. Seventy-nine patients fulfilled tentative criteria for CAWP; 72 (91%) experienced > or = 50% pain relief with anesthetic injection and were followed for at least three months (mean = 13.8 months). Abdominal pain in four patients was later diagnosed as caused by visceral disease. CAWP was confirmed in 56 of remaining 68 patients; 12 of 19 patients with recurrent pain were unavailable for re-injection of anesthetic. Thirty patients with confirmed CAWP had had diagnostic procedures to exclude visceral disease costing almost $700 per patient. CAWP is usually easily identified and treated; greater awareness should minimize misdiagnosis.
authors.affiliation: Michigan State University, Department of Medicine, East Lansing 48824-1315.
authors.forename: D S
authors.initials: DS
authors.lastname: Greenbaum
authors.forename: R B
authors.initials: RB
authors.lastname: Greenbaum
authors.forename: J G
authors.initials: JG
authors.lastname: Joseph
authors.forename: J E
authors.initials: JE
authors.lastname: Natale
mesh_terms: D000009:Abdominal Muscles; D015746:Abdominal Pain / Q000175:diagnosis / Q000191:economics / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000175:diagnosis; D010147:Pain Measurement