Chronic Abdominal Pain

There are many medical conditions which present with pain in the abdomen. The list could go on and on with diseases like a gall bladder stone, a peptic ulcer, or an acute appendicitis. It is extremely gratifying for the physician to discover and treat these. Sometimes multiple staged diagnostic testing is required in an effort to precisely diagnose the patient’s condition. Perhaps a laparoscopy or MRI scans or consultations may be necessarily obtained from many other physicians with specialized areas of expertise. The physician has to remain vigilant for disease processes presenting in some atypical fashion. This being said, however, sometimes pain in the abdomen is the disorder. Sufficient diagnostic testing will have been done to look for correctable causes of abdominal pain, though this is not to say that a pain management specialist will not be continually vigilant for new clues and other diagnostic signs. In specific instances the pain management specialist cannot just order one more test: the pain has to be addressed and treated. This is a special area of interest and expertise among physicians.

 Let’s discuss some sources of chronic abdominal pain. One common problem is adhesions between different bowel walls or between a bowel wall and the lining of the abdominal cavity, the peritoneum. One thing is for sure; the peritoneum has many sensory nerves associated with its structure and pulling on adhesions causes pain. Sometimes an effort is made to break the adhesions surgically, but they tend to reform after the belly is closed.  There are ligaments within the abdomen which hold up certain abdominal organs such as the liver, the duodenum, and other organs. These can become inflamed and scarred and cause pain in the abdomen. Sometimes an internal organ such as the pancreas can become chronically inflamed and cause chronic pain. Of course, there are medical management techniques which must be followed, but sometimes the patient is left with chronic severe pain which must be addressed.

The pelvis is sometimes addressed separately, but it is indeed part of the abdomen. The pelvic peritoneum, the lining, can become inflamed and form adhesions. There can be inflammatory conditions including chronic infection or other problems. Even when optimal medical or surgical treatment is completed, the patient may be left with chronic pain. The pain becomes the disease rather than a symptom of the disease, and as such must be addressed in a separate manner.

Pain management has evolved over the past several years as a specific discipline and area of interest. There is an accumulated knowledge of treatment modalities like physical therapy, use of antidepressant and anti-seizure drugs, acupuncture, and skillful use of stronger pain medicines on a chronic basis that can significantly improve one’s life and daily living. The same is certainly true of the abdomen and pelvis: once adequate medical diagnostic techniques have been completed, treat the pain. Use the accumulated skills of Pain Management to be sure that no patient has to walk around unnecessarily in pain when it could be skillfully treated and managed. Improved quality of life is a primary goal of pain management.