The primary aim of this randomized clinical trial is to investigate the effects of ultrasound guided transversus abdominis plane (TAP) versus ultrasound guided trigger point injections (TPIs) on numerical rating scale (NRS) pain scores at month 3 follow-up in patients with a chronic abdominal wall pain (AWP). The primary outcome measure was the difference in mean numeric rating scale pain scores between the TAP and TPI groups at month 3 in an intent-to-treat (ITT) analysis. A total of 60 patients were randomized 1:1 to receive an ultrasound-guided TAP block (n=30) or an ultrasound-guided TPI (n=30). No significant group differences in baseline demographic or clinical characteristics were observed. The mean baseline pain score for the TAP and TPI groups were 5.5 and 4.7, respectively. In the ITT analysis at month 3, the between group difference in pain scores was 1.7 (95% CI, 0.3 to 3.0) favoring the TPI group. In a secondary per-protocol analysis, the between group difference in pain scores was 1.8 (95% CI, 0.4 to 3.2) favoring the TPI group. For the ITT and per-protocol analyses, the group differences in pain scores were consistent with a medium effect size. The main finding of this randomized clinical trial is that adults with chronic AWP who received a TPI reported significantly lower pain scores at month 3 follow-up compared to patients who received a TAP block.Copyright © 2021 International Association for the Study of Pain.