Abdominal Pain After Resolution of Autoimmune Pancreatitis: The Use of Acupuncture for the Myofascial Sequelae of Visceral Disease

Abstract

Abstract

Background:

Treatment options for functional abdominal pain are limited, often leading patients to seek help with acupuncture. Although there is evidence supporting the use of acupuncture for these patients, its mechanisms of action remain unclear. This article describes the case of a patient with severe visceral pathology who continued to have chronic abdominal pain despite complete resolution of her disease process. Her physical examination and robust treatment response to acupuncture and trigger-point (TrP) injections suggest that her pain had become myofascial in nature. This example is used to review the connection between visceral pain and somatic myofascial TrPs as a mechanism of acupuncture in some cases of functional abdominal pain.

Case:

Patient: A 58-year-old female with a history of autoimmune pancreatitis in remission presented with severe abdominal pain that was refractory to medications and a celiac plexus blockade. An endoscopic retrograde cholangiopancreatogram was notable for a pancreatic-duct stricture; however, successful stenting of the stricture did not reduce her pain, so it was determined to be functional in nature. Interventions: Acupuncture, TrP injections, self-acupressure, and self-moxibustion were applied in her case.

Results:

She had dramatic improvement from a short course of acupuncture therapy, but her pain returned soon after. TrP injections, self-acupressure and self-moxibustion were then added and the patient's pain resolved with future pain episodes treated without the use of medication.

Conclusions:

Myofascial pain should be considered as a source of pain in patients with chronic abdominal pain following treatment of visceral pathology, and acupuncture should be considered as a treatment option.