It is normal to have a bellyache once in a while, but many people have pain of the abdomen that comes and goes for the duration of their lives. Chronic abdominal pain is defined as lasting more than three months. There are many neurological causes of chronic abdominal pain.
What symptoms are associated with chronic abdominal pain?
Chronic abdominal pain is often associated with:
- Pain that is not associated with eating or physical activity
- Dull, aching pain
- Sharp, shooting pain
- Nausea and/or vomiting
- Constipation and/or diarrhea
- Swelling of the intestines
- Stretching of organs
- Blood loss
What causes chronic abdominal pain?
Chronic abdominal pain can be caused by:
- Inflammatory bowel disease (Crohn’s and ulcerative colitis)
- Irritable bowel syndrome
- Chronic pancreatitis
- Recurrent urinary tract infection
- Stress and anxiety
What is functional abdominal pain syndrome (FAPS)?
Functional abdominal pain syndrome causes a variety of symptoms from painless diarrhea and constipation to severe stabbing pain. This functional GI disorder cannot be diagnosed with laboratory and diagnostic tests. For patients with FAPS, the pain often is debilitating, affecting overall quality of life. According to a recent survey, people with FAPS miss up to 14 days of work each year due to this problem.
How is chronic abdominal pain diagnosed?
The doctor will conduct testing to evaluate chronic abdominal pain. This includes:
- Abdominal computed tomography – Using specialized computer software and x-ray technology, a CT scan creates 3-D images of the abdominal organs and structures.
- Laboratory testing – The doctor may order a complete blood count (CBC), electrolytes, renal function panel, albumin tests, and liver function tests.
- Colonoscopy – To examine the intestines, the doctor can perform a colonoscopy or sigmoidoscopy.
- Small intestine x-ray – A standardized x-ray of the intestine helps diagnosed blockages and impactions.
- Stool culture – The doctor will examine the feces for occult blood, white blood cells, and evidence of food intolerances.
How is chronic abdominal pain treated?
Many people with chronic pain have normal tests results. The pain management specialist will work closely with other physicians to treat your pain. The aim of treating functional abdominal pain involves controlling symptoms and improving daily function. The brain affects your sense of pain and has the ability to block pain. Nerve impulses travel from the abdomen to the spinal cord. Options for treatment include:
- Relaxation techniques – This includes guided imagery, breathing exercises, and meditation.
- Behavioral therapies – The most popular include psychotherapy and cognitive-behavioral therapy.
- Medications – The pain specialist will evaluate your current medications and advise you on which ones to take. Ibuprofen, naproxen, and aspirin often cause abdominal discomfort.
- Celiac plexus block – The doctor may recommend acupuncture or a celiac plexus block for the pain. The doctor injects an anesthetic and/or neurolytic agent onto nerves surrounding the abdominal artery. The efficacy rate for this procedure is 85-90%, according to a recent clinical study.
- Intrathecal pain pump – This involves insertion of a small needle and catheter near the spine. The patient received an infusion of pain medicine, which conveniently bypasses the gastrointestinal tract.
- Superior hypogastric block – With this procedure, the doctor injects a neurolytic agent and/or anesthetic onto the plexus of nerves near the lower spine. The superior hypogastric plexus supplies the bladder, pelvic organs, and rectum. This procedure is good for lower abdominal pain. Based on clinical studies, the success rate for this block is 70-75%.
- Acupuncture – This traditional Chinese therapy is used for pain reduction. The practitioner inserts tiny needles along meridians, which are areas of the body. This procedure alleviates pain, restores body energy, and relieves stress.
- Medications – These are used for severe abdominal pain. Options include antidepressants and opioid analgesics.
Levy, M., & Wiersema, M. (2012). Endoscopic ultrasound-guided celiac plexus and ganglia interventions. Retrieved from UpToDate.
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