Rhim Hye Chang, Cha Jae Hyun, Cha Jaehyung, Kim Dong Hwee
Korea University College of Medicine, Seoul.
Medical Science Research Center, Korea University Ansan Hospital, Ansan.
Medicine (Baltimore). 2020 Dec 4;99(49):e23408. doi: 10.1097/MD.0000000000023408.
Even though chronic abdominal pain is 1 of the most common reasons for hospital visits, diagnostic testing is often time-consuming and treatment is inadequate. Abdominal myofascial pain syndrome (AMPS) is usually not included as a differential diagnosis, but it should be considered in cases of chronic abdominal pain. The purpose of this study was to investigate the clinical characteristics of AMPS and to assess the effect of sonography-guided trigger point injections (TPI).A total of 100 patients with AMPS from 2012 to 2018 were retrospectively evaluated for clinical characteristics and TPI effects. AMPS was diagnosed using Srinivasan and Greenbaum's criteria, and the TPIs were performed at intervals of 2 to 4 weeks. The Visual Analog Scale (VAS) ratio was calculated by subtracting the final VAS from the initial VAS score and dividing it by the initial VAS score after injections, and the patients were divided into 4 groups: non-responders, mild, moderate, and good responders.The median duration of pain was 12 months, and the median number of hospital visits before TPI was 2. Of the 100 patients, 66 (66%) were categorized as good responders, 11 (11%) as moderate responders, 7 (6.9%) as mild responders, and 16 (15.7%) as non-responders. When the initial and final VAS scores were compared, the sonography-guided injections were found to be effective in alleviating pain (P < .001). Moreover, patients who received the injections 2 or more times tended to have more significant pain reduction than those who received a single injection (P < .001).Patients with AMPS suffer from long-term pain and undergo many hospital visits and diagnostic tests. TPI with lidocaine can be an effective and safe treatment for patients with chronic AMPS.
尽管慢性腹痛是住院就诊最常见的原因之一，但诊断性检查通常耗时且治疗不充分。腹部肌筋膜疼痛综合征（AMPS）通常不被纳入鉴别诊断，但在慢性腹痛病例中应予以考虑。本研究的目的是调查AMPS的临床特征，并评估超声引导下触发点注射（TPI）的效果。
对2012年至2018年期间共100例AMPS患者进行回顾性评估，分析其临床特征及TPI效果。采用Srinivasan和Greenbaum的标准诊断AMPS，并每隔2至4周进行一次TPI。通过用初始视觉模拟评分（VAS）减去最终VAS，再除以注射后的初始VAS评分来计算VAS比值，将患者分为4组：无反应者、轻度反应者、中度反应者和良好反应者。
疼痛的中位持续时间为12个月，TPI前的中位住院次数为2次。100例患者中，66例（66%）为良好反应者，11例（11%）为中度反应者，7例（6.9%）为轻度反应者，16例（15.7%）为无反应者。比较初始和最终VAS评分时，发现超声引导下注射在减轻疼痛方面有效（P<0.001）。此外，接受2次或更多次注射的患者比接受单次注射的患者疼痛减轻更显著（P<0.001）。
AMPS患者长期遭受疼痛折磨，需要多次住院就诊和进行诊断性检查。利多卡因TPI对慢性AMPS患者可能是一种有效且安全的治疗方法。
