Interpretation
Clinician fixation on visceral abdominal pain at the exclusion of somatic abdominal wall pain as a differential diagnosis leads to protracted testing, unsatisfactory treatment and substantial cost – both in terms of healthcare finance and patient suffering (7, 14-19). Accurately placed local anaesthetic injections give immediate, substantial pain relief to more than 75% of patients with AWP, often for prolonged periods of time (7). The topic is frequently discussed in publications related to gastroenterology, paediatrics, pain, emergency medicine and general surgery (7-9. 15-17, 22). This study suggests that AWP could be relevant for obstetric patients too.
New Zealand’s antenatal healthcare model is multidisciplinary. The patient’s Lead Maternity Carer provides all routine antenatal visits. These are most often midwives, but can be general practitioners or obstetricians. It is routine for low risk patients to never meet a doctor during their pregnancy and for high risk patients to receive most of their care from obstetricians. Patients with abdominal pain in pregnancy often have consultations with physiotherapists or pain physicians. Participants in this study were recruited from obstetric clinics. We emphasise that when participants label ‘medical carers’ as the source of their education on RLP, we are not indicting one discipline over another. The interrogation of the concept of RLP should be shared amongst all obstetric clinicians.
Taking a history and examining patients with abdominal wall neuropathy is efficient and rewarding. We encourage obstetricians to ask their patients in pain the abovementioned questions and examine them looking for allodynia, hyperalgesia, dysesthesia and pain on abdominal wall tensing. A diagnostic and therapeutic ultrasound-guided TAP block is low risk and easy to perform (7).