There are several reasons that can result in severe pain in the chronic abdominal wall: post-surgical pain, peripheral nerve entrapment, muscle problems… Other that oral medication, there are other weapons to control this pain: ultrasound-guided percutaneous techniques. TAP block (Transversus Abdominal Plane), Thermal Radiofrequency or Crioablation of peripherical nerves, are just a few examples in our clinical practice.
Most Common Syndromes
There are a few overlooked yet common causes for abdominal wall pain, which should be sought in the presence of chronic abdominal pain.
This syndrome is a common and frequently missed cause of chronic abdominal pain, characterized by the entrapment of cutaneous branches of intercostal nerves. The pain is usually aggravated by any movement of abdominal muscles and treatment should begin with ultrasound-guided nerve blocks.
Thoracic radiculopathy is uncommon but can be the cause of abdominal wall pain as inferior thoracic nerves innervate this area. Treatment should be multimodal, including medication, physiotherapy, specific image-guided injections and eventually surgery.
This syndrome is characterized by hypermobility of the anterior ends of the costal cartilages of the false ribs leading to impingement of the intercostal nerve and consequently intermittent but severe lower rib and abdominal pain. Depending on severity, treatment may include medication plus physiotherapy, ultrasound-guided nerve block, or surgery.
Peripheric Nerve Block
This minimally invasive procedure, as radiofrequency ablation and cryoablation, should be guided for ultrasound or fluoroscopy.
Pharmacological management pain is commonly part of the treatment and a wide range of drugs can be used to manage pain.
”Before I start with my trip through the Pain Center I would like to say thank you to Dr. Costa and his wonderful team. I feel much better than before.Karola KoenigGermany
”After the treatment I am only happy to say how I really feel. With some stretch exercises and physiotherapy, I feel great and get on with my life. Thanking you.Carole LeeThe Netherlands