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).