Can the trapezius (traps) muscle or vexas cause abdominal pain?

Abdominal Pain in VEXAS Syndrome

VEXAS syndrome can cause abdominal pain as part of its systemic inflammatory manifestations, while the trapezius muscle (traps) is not associated with abdominal pain.

VEXAS Syndrome and Abdominal Pain

VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is a recently described autoinflammatory condition that can present with various systemic manifestations, including abdominal pain. The World Journal of Emergency Surgery notes that severe pain with minimal exam findings can suggest mesenteric ischemia, which is a potential manifestation in inflammatory conditions 1.

Pathophysiology of Abdominal Pain in VEXAS

• Systemic inflammation can affect mesenteric vessels
• Inflammatory processes may cause visceral hypersensitivity
• Pain may be out of proportion to physical examination findings

Trapezius Muscle and Abdominal Pain

The trapezius muscle is anatomically located in the upper back and neck region, extending from the occipital bone to the lower thoracic vertebrae and laterally to the spine of the scapula 2. Based on its anatomical location and function:

• The trapezius has no direct anatomical connection to abdominal structures
• Pain from the trapezius typically radiates to the neck, shoulders, and upper back
• There is no evidence in the medical literature supporting trapezius muscle involvement in causing abdominal pain

Differential Diagnosis for Abdominal Pain

When evaluating abdominal pain in a patient with suspected VEXAS or other systemic inflammatory conditions, consider:

1. Mesenteric ischemia: Severe pain with minimal exam findings 3, 1

   • Requires urgent evaluation due to high mortality rate (up to 70%)
   • May present with post-prandial pain, weight loss, and food fear

2. Abdominal wall pain: Often overlooked source of abdominal pain 4, 5, 6

   • Characterized by:
     • Localized tender trigger points
     • Pain related to posture or movement
     • Positive Carnett's sign (pain unchanged or increased when abdominal muscles are tensed)

3. Functional abdominal pain: Common in chronic inflammatory conditions 7

   • May involve peripheral sensitization of visceral afferents
   • Central sensitization of the spinal dorsal horn
   • Aberrancies in descending modulatory systems

4. Irritable bowel syndrome: Often coexists with systemic inflammatory conditions 3

   • Characterized by altered bowel habits and abdominal pain
   • May be exacerbated by stress and inflammation

Management Approach

For abdominal pain in patients with VEXAS syndrome:

1. Evaluate for mesenteric ischemia if pain is severe and out of proportion to exam findings 3

   • Consider contrast-enhanced CT for diagnosis
   • Early intervention is critical to avoid bowel infarction

2. For chronic abdominal pain:

   • First-line: Anti-spasmodics or peppermint oil for pain relief 3
   • Second-line: Neuromodulators such as tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) 3
     • TCAs should be first choice for abdominal pain, initiated at low doses
     • SSRIs are an alternative if symptoms don't respond to TCAs

3. For severe or refractory pain:

   • Consider combination therapy with neuropathic analgesics (e.g., duloxetine plus gabapentin) 3
   • Be vigilant for serotonin syndrome with certain combinations, especially those involving both SSRIs and SNRIs 3

Key Points to Remember

• VEXAS syndrome can cause abdominal pain through inflammatory mechanisms
• The trapezius muscle is not anatomically or physiologically linked to abdominal pain
• Careful evaluation is needed to distinguish between various causes of abdominal pain
• Treatment should target the underlying inflammatory process in VEXAS while providing symptomatic relief
• Avoid opiates for chronic abdominal pain as they are generally ineffective 3

When abdominal pain occurs in a patient with VEXAS syndrome, it should be considered a manifestation of the underlying inflammatory condition until proven otherwise, particularly if the pain is severe or out of proportion to examination findings.