Abdominal Wall Pain Is Frequently Underdiagnosed Leading to Wasted Healthcare Resources

Myofascial abdominal wall pain (AWP) is a well-recognized presentation of chronic abdominal pain which can be diagnosed solely based on history and a focused physical exam in the out-patient setting. However, current clinical practices rely on diagnostic imaging studies and invasive procedures which can lead to incorrect or delayed diagnosis. We assessed the clinical implications of AWP misdiagnosis and associated healthcare costs in diagnosing AWP in a tertiary care medical practice. In this retrospective single center study, patients undergoing trigger point injections (TPI) for suspected AWP were selected based on the current procedural terminology code 20552. AWP was defined based on a history of localized abdominal pain and a positive Carnett’s sign on physical exam with immediate relief on trigger point injection. The following procedures are most commonly performed exclusively for the diagnosis of abdominal pain: EGD with biopsy, endoscopic ultrasound, CT of the abdomen w/contrast, MRI of abdomen, and TPI. Healthcare costs were estimated based on data from Centers for Medicare and Medicaid claims database. A paired t-test was used to compare means and a p-value less than 0.05 was considered statistically significant. A total of 36 patients (32 women, 49 ± 3 years) diagnosed with AWP underwent 40 TPI from January 2023 through January 2024. All patients had immediate pain relief with TPI, confirming clinical and technical success. The associated total healthcare cost of unnecessary diagnostic studies alone was $155,307 (an average cost of $4,198 per patient). As healthcare costs continue to increase, an emphasis on clinically appropriate history and physical exam may decrease healthcare costs and reliance on invasive procedures and imaging studies.