Abdominal Pain Syndromes

CHRONIC ABDOMINAL PAIN

Chronic abdominal pain is defined as continuous or intermittent abdominal discomfort/pain lasting for more than three months. Abdominal pain can be caused by any structure of the abdomen, pelvis, chest, or back such as an organ, gut, vasculature, or nerves. Chronic abdominal pain can be caused by the anatomic, physiologic, or metabolic causes of these structures or from a functional disorder arising from multifactorial reasons due to the malfunction of any organ or the brain-gut axis.   It must be noted that causes of chronic abdominal pain can be quite complex and sometimes difficult to diagnose. However, a comprehensive methodic approach utilized by the interventional pain specialist generally leads to a proper diagnosis and can ultimately be treated.

Some examples of chronic abdominal pain are GI disorders such as irritable bowel syndrome (IBS), functional dyspepsia, SIBO, Microbiome abnormalities, inflammatory diseases of the GI tract, endocrine disorders, Diverticulitis, Stretching or Distention of an organ such as obstruction of the intestine, blockage of a bile duct by gallstones, swelling of the liver with hepatitis, Loss of the supply of blood to an organ such as Ischemia (blood restriction), Ulcerative Colitis, Chrones disease and so on.

Signs and Symptoms can include but not  limited to:

  • Fever
  • Anorexia, weight loss
  • Pain constant or that awakens the patient
  • Blood in stool or urine
  • Jaundice
  • Edema
  • Abdominal mass or organomegaly (enlarged organ), distension
  • Muscle spasm of the abdominal wall or internal, cramping

Testing:

  • Urinalysis
  • CBC (complete blood count)
  • Liver tests ESR (Erythrocyte sedimentation rate)
  • Amylase
  • Lipase
  • CT of the abdomen and pelvis with contrast
  • Upper GI endoscopy or colonoscopy
  • X-rays
  • Stool testing

Diagnosis:

A comprehensive physical exam and medical history to establish an understanding of an individual’s subjective complaints of location, quality, duration, timing and frequency of recurrence, and factors that worsen or relieve pain (particularly eating or moving bowels). A specific inquiry as to whether milk and milk products cause abdominal cramps, bloating or destetion is needed, because lactose intolerance is common, especially among African Americans. In adolescents, a diet history is important because ingestion of large amounts of cola beverages and fruit juices (which may contain significant quantities of fructose and sorbitol) can account for otherwise puzzling abdominal pain. Pasts medical history should include nature and timing of any abdominal surgery and the results of previous tests that have been done and treatments that have been tried. A drug history should include details concerning prescription and illicit drug use as well as alcohol.

Treatment:

  • Drug Therapy
  • Physical Therapy
  • Anesthetic/Corticosteroid Injections
  • Cognitive methods
  • Regular follow-up visits should be scheduled weekly, monthly, or bimonthly, depending on the patient’s needs, and should continue until well after the problem has resolved.
  • Psychiatric referral may be requied if symptoms persist, especially if the patient is depressed or there are significant psychologic difficulties in the family.

Chronic pancreatitis is an inflammation of the pancreas that develops over a number of years, usually after a history of recurrent attacks of acute pancreatitis.

Signs and Symptoms:

  • Abdominal Pain
  • Nausea, Vomiting, and Anorexia
  • Fever
  • Fast Heart Rate (Tachycardia) 
  • Sweating
  • Yellowing of the Skin (Jaundice)
  • Bloated or Swollen Belly

Testing:

  • Lab Work
  • CT Scan

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatment:

  • Drug Therapy
  • Celiac Plexus Block

Visceral pain is the pain we feel when our internal organs are damaged or injured. 

Some causes are:

  • Injury
  • Inflammation

Signs and Symptoms:

  • Referred/transferred pain to cutaneous structures
  • Diffuse and difficult to localize
  • Enhaced autonomic and/or motor reflexes
  • Cutaneous and deep tissue hyperalgesia (increased sensitivity)

Testing:

  • X-Rays
  • MRI
  • Biopsies

Diagnosis:

A comprehensive physical exam and medical history to establish an understanding of an individual’s subjective complaints of pain and characteristics of the pain such as: onset/offset, character/radiation of pain, associated symptoms, time pattern, exacerbating/ameliorating factors and severity.

Treatment:

  • Drug Therapy
  • Physical Therapy
  • Anesthetic/Corticosteroid Injections
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Psychotherapy
  • Behavioral methods of pain control

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