Abdominal Pain

The term abdominal pain refers to pain originating from the tissues, structures, and organs of the abdominal abdominal pain5cavity, such as the muscles, bones, stomach, intestines, liver, pancreas, gallbladder, and spleen. The abdomen is the area below the ribs and diaphragm and above the pelvic bone. For many patients, problems with the spine can result in what is called “referred” pain. This means the pain originates in one location but it is felt in another.

Chronic abdominal pain (CAP) persists for more than three months, either intermittently (comes and goes) or continuously (all the time). Approximately 2% of adults have CAP, mainly women. The majority of people with CAP have had a thorough medical evaluation that did not yield a diagnosis. Functional abdominal pain syndrome (FAPS) is a condition where pain persist for six months or more without any evidence of disease or connection to another factor, such as menses, bowel movements, or eating.

Causes of Abdominal Pain

Scientists and doctors do not fully understand the cause of CAP or FAPS. However, experts believe that sensory nerves of the spinal cord become abnormally excited and sensitive due to cognitive and psychological factors. These factors include stress, depression, and coping mechanisms. This contributes to efferent stimulation that amplifies the pain signals, which results in perception of pain. In addition, the pain may function as a stressor.

Many short- and long-term diseases cause abdominal pain. The serious causes of abdominal pain include appendicitis, gastric ulcer, gallbladder disease, pregnancy-associated conditions, kidney stones, heart attack, ruptured blood vessels, diverticulitis, and loss of blood flow to the intestines. Additionally, diseases of the Abdominal-Paingroin or pelvis can cause the abdomen to hurt.

Irritable Bowel Syndrome (IBS)

A common disorder that affects the large intestine (colon) and causes pain is irritable bowel syndrome (IBS). Many patients with chronic functional abdominal pain suffer from IBS. With this condition, the pain is described as cramping, and the discomfort is accompanied by bloating, diarrhea, constipation, and gas. Patients with IBS must learn to control symptoms by managing lifestyle, diet, and stress.

The risk factors for IBS include:

  • Age – People under 45 years suffer from IBS most.
  • Female gender – Women are twice as likely to have the condition.
  • Family history – Studies suggest that individuals with a family history of IBS are at increased risk for the disorder.
  • Mental health condition – Certain mental conditions increase the risk for IBS, such as depression and anxiety.

Treatment for Abdominal Pain

  • Celiac plexus block – This is a treatment used for patients with chronic abdominal pain. Under x-ray guidance, the doctor places a needle in the back, which delivers numbing medication to the celiac plexus (group of nerves). Contrast dye is used to confirm the needle is in the correct spot. According to resent clinical trials, the celiac plexus block is effective 85 to 90% of the time.

 

  • Epidural catheter – For select patients, an epidural catheter is placed in the spine, and pain medication is infused around the spinal nerves as they exit from the sCeliac Plexus Blockspinal cord. This technique provides pain relief for patients who have recently had surgery.

 

  • Patient controlled analgesia (PCA) – When there is long-standing CAP or FAPS, the pain management specialist may recommend a PCA pump. This involves delivery of strong pain medication via IV method. The patient can control the timing and dosing of the medicine for optimum effect.

 

  • Superior hypogastric plexus block – This involves inserting a needle into the back under x-ray guidance. Once in position, the doctor verifies placement and injects a small amount of local anesthetic, and sometimes a neurolytic agent, onto the hypogastric plexus (nerve mass). According to research studies, this block is effective for treating pelvic and abdominal pain associated with cancer (relief in 72% of patients), as well as pain not related to cancer (reports of 6 months of pain relief).

 

  • Medications – The pain management specialist often uses one or more medications to treat a patient with chronic abdominal discomfort. The medication regimen is tailored to meet the unique pain issues of the patient.

 

 

Resources

Clouse RE, Mayer EA, Azia Q, Drossman DA, et al. (2006). Functional abdominal pain syndrome. Gastroenterology, 130(5), 1492-1497.

Mayo Clinic (2014). Irritable bowel syndrome. Retrieved from: http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/con-20024578