535: Transversus Abdominis Plane Blocks in Chronic Abdominal Pain: Factors Influencing Treatment Response

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary visceral / pelvic pain, Non-pharmacological treatments, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Chronic abdominal pain (CAP) is a common complaint seen by pain physicians, with increasing prevalence.(1,2) Transversus abdominis plane (TAP) blocks have been increasingly used in the outpatient setting to treat CAP of varying etiologies.(3-5) A recent study identified multiple predictors of treatment response, including body mass index (BMI), neuropathic symptoms, pain duration, and the presence of depression or fibromyalgia.(6) However, this study included a small sample size. Our study aimed to investigate predictors of TAP block response in CAP on a larger scale, while also incorporating procedural data to further elucidate factors that may influence treatment success.

Methods: A retrospective observational study was conducted, which enrolled patients with chronic abdominal pain who underwent TAP blocks. One hundred eighty-seven patients with 3-month follow-up were classified as responders or non-responders based on improvements in pain rating scores (30% improvement), PROMIS(7,8) physical function scores (at least 5-point improvement), or global impression of treatment efficacy (“very much improved” after treatment). Patient demographics, socioeconomic data, and information from the Patient Outcomes Repository for Treatment (PORT)(9) were analyzed at baseline and 3 months after receiving a TAP block. Procedural data was obtained through chart review.

Results: Amongst this cohort, 80 patients were responders to treatment, and 107 were non-responders. At baseline, treatment responders reported significantly fewer pain regions on patient body maps, a difference that persisted at 3 months. No other demographic or clinical variables were significantly associated with TAP block success. There were no significant differences in age, sex, pain duration, BMI, or baseline fibromyalgia, anxiety, or depression. Procedural variables, including steroid use, total anesthetic volume, number of TAP blocks within 3 months, and whether injections were performed bilaterally or unilaterally, were not associated with treatment response.

Conclusions: This study's findings suggest TAP blocks may be effective for chronic abdominal pain independent of BMI, neuropathic or depressive symptoms, pain duration, or fibromyalgia diagnosis, in contrast to prior literature. Notably, the number of pain body regions was associated with treatment efficacy, as patients with fewer body regions involved were more likely to benefit from TAP blocks. These findings suggest that patients with widespread pain, even with abdominal pain present, may demonstrate reduced responsiveness to TAP blocks, and warrants further investigation. Pain distribution may therefore serve as a clinically useful predictor of treatment response.

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6. Freo U, Furnari M. Long-Term Outcome and Predictors of Transversus Abdominis Plane Block for Chronic Post-Hernioplasty Pain. J Clin Med. 2024 Jul 10;13(14):4039. doi: 10.3390/jcm13144039. PMID: 39064080; PMCID: PMC11278023.

7. Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, Ader D, Fries JF, Bruce B, Rose M; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care. 2007 May;45(5 Suppl 1):S3-S11. doi: 10.1097/01.mlr.0000258615.42478.55. PMID: 17443116; PMCID: PMC2829758.

8. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010 Nov;63(11):1179-94. doi: 10.1016/j.jclinepi.2010.04.011. Epub 2010 Aug 4. PMID: 20685078; PMCID: PMC2965562.

9. Dressler AM, Gillman AG, Wasan AD. A narrative review of data collection and analysis guidelines for comparative effectiveness research in chronic pain using patient-reported outcomes and electronic health records. J Pain Res. 2019 Jan 24;12:491-500. doi: 10.2147/JPR.S184023. PMID: 30774419; PMCID: PMC6353217.

Presenting Author: William Schultze, DO
Submitting Author: Will Schultze

Senior Author: Benedict J. Alter, MD, PhD

IASP 2026 Global Year theme of Neuropathic Pain: No

• Maya Maurer: MS - University of Pittsburgh Medical Center (UPMC)
• Rebecca DeSensi: MS - University of Pittsburgh Medical Center (UPMC)
• Ajay D. Wasan: MD - University of Pittsburgh Medical Center (UPMC)
• Trent Emerick: MD - University of Pittsburgh Medical Center (UPMC)
• Benedict J. Alter: MD, PhD - University of Pittsburgh Medical Center (UPMC)