CHRONIC ABDOMINAL-WALL PAIN - DIAGNOSTIC VALIDITY AND COSTS

Chronic abdominal wall pain (CAWP) is common and frequently mistaken f or visceral pain. We determined the stability of this diagnosis with M ain Outcome Measures of: (a) change of pain intensity after local anes thetic-corticosteroid injection, (b) pain relief after three or more m onths follow-up, and (c) costs of diagnostic procedures for visceral c auses of abdominal pain in patients with confirmed CAWP. Seventy-nine patients fulfilled tentative criteria for CAWP; 72 (91%) experienced g reater than or equal to 50% pain relief with anesthetic injection and were followed for at least three months (mean = 13.8 months). Abdomina l pain in four patients was later diagnosed as caused by visceral dise ase. CAWP was confirmed in 56 of remaining 68 patients; 12 of 19 patie nts with recurrent pain were unavailable for re-injection of anestheti c. Thirty patients with confirmed CAWP had had diagnostic procedures t o exclude visceral disease costing almost $700 per patient. CAWP is us ually easily identified and treated; greater awareness should minimize misdiagnosis.