Trigger point injections for abdominal wall pain: Discussion (Part 3)
Greenbaum et al therefore modified the Carnett test to include additional criteria as outlined in the present paper, and it has been shown to have a sensitivity of 85% and specificity of 97%. By comparison, the Carnett test alone was 78% sensitive and 88% specific. Not surprisingly, in our study, it was the patients who met these criteria for AWP that benefited the most from TPI. The absence of GI symptoms was a predictor of response to TPI. The location of the pain was also a predictor of response. It seems as if pain located in the upper abdomen responds better than that in the mid to lower abdomen. Buy Asthma Inhalers Online One possible explanation for this is related to the ease of injecting the upper abdomen. The upper abdomen is generally less fatty than the lower abdomen. In our experience, we have found it easier to pinpoint and infiltrate trigger points in the upper abdomen, leading to better results.
One of the results that were a bit surprising was the lack of difference in efficacy when a steroid was added to the local anesthetic. It has been thought that steroids enhance the anesthetic effect or provide more prolonged relief. There have been several hypotheses put forth as to how steroids may be of benefit. One of these is that steroids may reduce ectopic discharges from neuromas.