Patient with abdominal wall pain and no distinct triggers had bilateral pulse radiofrequency to T10 and 11. This brought pain levels down from 6/10 to 1/10 at 10 weeks by procedure and still relief after 10 months. Though their case was neurogenic type of pain, one wonders if it would help other abdominal pains
- 33 year old
- Had prior abdominal surgery – they felt multiple prior abdominal surgery cases would be best candidates
- pain more neurogenic – stabbing and sharp with electrical sensations mainly over the hypogastric region and occasionally radiating to the back.
- 4-5 attacks of nausea /day
- nothing helped
- “no diagnostic modality could identify a visceral or anatomic source”.
Rx:
- with a transforaminal 0.25% bupivacaine injection at the T10 –T11 level was used to confirm benefit
- Pulse radiofrequency bilateral to T10 and T11 gave immendiate relief – dropping pain to 1/10 and relief persisted
- It was estimated 10-30 of chronic abdominal pains are Anterior cutaneous nerve entrapment syndrome(ACNES). This is nerve entrapment usually diagnosed by having pateint lift his heels off the table (and maybe elevate head) and press on various abdominal wall sites until trigger found. The local injections of local (and perhaps steroid) might have benefit.
- T9-12 feed abdominal wall and might benefit from treatment for chronic abdominal wall pains
- T10 is the most commonly ablated level
Comment – I find abdominal wall pains become part of most chronic abdominal wall problems and treatment there would make a difference. A previous report found pulse radiofrequency to intercostal nerves was safer than to nerve root ganglion – I wrote about that below and I suggest semineurolytic injections of concentrated local , could work as well. I use 5-6% liocaine in 5% dextrose and find that a series of 3 shots has lasting benefits without fear of dysthesias
Post Herpetic Neuralgia – Pulse Radiofrequency to Dorsal Ganglion Treatment -and Various Intercostal and Infraorbital Nerve Blocks and Beyond
http://painmuse.org/?p=2865
My feeling is that this offers exciting possibilities for all chronic abdominal pain issues and intercostal nerve root blocks to T9-12 might not be that difficult. I would start with a t10 blocks and work from there. One wonders if it could help chronic nausea.