Basics of Top Abdominal Pain Treatment

Everyone experiences abdominal pain at some time during life. It has many causes, such as indigestion, pancreatitis, and appendicitis. Abdominal pain can be benign or serious. Medical professionals consider abdominal pain to be chronic when it lasts longer than six months. Chronic abdominal pain is often identified as a problem of the endocrine, gastrointestinal, or reproductive systems in the body.

How common is abdominal pain?

Chronic abdominal pain affects 22 people per 1,000 person-years, and around 25% of the adult population has abdominal pain at some point in life. According to a national telephone survey of U.S. households, 22% of people reported abdominal pain. This study found that abdominal pain affects women more often than men.

How is chronic abdominal pain diagnosed?

The doctor may run several tests to identify what causes chronic abdominal pain. Common tests used to diagnose this problem include:

• Computed tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Endoscopies
• Colonoscopies
• Ultrasounds
• Endoscopic retrograde cholangiopancreatographies (ERCP’s)
• Magnetic resonance cholangiopancreatographies (MRCP’s)
• Blood, fecal, and urine tests

These tests are used to assess the functioning of various body systems of the abdomen. It is necessary to rule out potential causes of abdominal pain, such as Crohn’s disease, endometriosis, cancer, and irritable bowel syndrome. Sometimes, the cause of chronic abdominal pain is unknown.

What causes chronic abdominal pain?

The small intestine begins at the bottom of the stomach. This 20 foot organ is where vitamins and nutrients are absorbed. The large bowel (colon) attaches to the small intestine and is around 5-6 feet long. Pain of the abdomen is associated with pacemaker nerve cells in the muscles that lie in the wall of the intestine. These cells initiate intestinal contractions, and send pain signals to the brain. Certain chemicals and hormones in the intestines influence the action of the intestine. In addition, stress of any form will influence how the intestine works.

Common causes of chronic abdominal pain are:

• Irritable bowel syndrome
• Chronic pancreatitis
• Inflammatory bowel disease (Crohn’s and ulcerative colitis)
• Endometriosis
• Constipation
• Chronic pancreatitis
• Stress and anxiety
• Recurrent urinary tract infection

What symptoms are associated with chronic abdominal pain?

The pain related to chronic abdominal pain is described as dull and achy, but it may develop into sharp and shooting pain at times. Many patients have had multiple abdominal surgeries, and there is often a history of sexual abuse in childhood. Symptoms include fever, weight loss, and rectal bleeding. The symptoms associated with chronic abdominal pain are not the same for every patient.

How is chronic abdominal pain treated?

The goal of treatment for chronic abdominal pain is to improve quality of life and control symptoms. Treatment involves:

• Tricyclic antidepressants – These include trazodone and amitriptyline. These medicines stimulate the brain to increase nerve signals that work to block pain nerve impulses from the abdomen.
• Selective serotonin reuptake inhibitors (SSRIs) – These include Paxil, Zoloft, Prozac, and Celexa. These drugs work by increasing the amount of brain chemicals.
• Relaxation techniques – This includes breathing exercises, guided imagery, and meditation.
• Celiac plexus block – This involves injecting an anesthetic agent onto nerves that surround the abdominal artery (called the celiac plexus). A neurolytic agent, such as phenol, may be added to maximize effectiveness. According to a recent research study, this block has an 85-90% efficacy rate.

• Superior hypogastric block – This involves injecting the superior hypogastric nerve bundle that is positioned near the lower spine. An anesthetic, and possibly a neurolytic agent, is instilled onto the nerves that supply the pelvic organs and bladder region. The efficacy rate for this block is around 75%, based on results of clinical studies.
• Intrathecal pain pump – A small pump can be implanted into the body. A catheter runs from the pump to the spine, and this delivers medication directly to the nervous system. This way, the medication bypasses the gastrointestinal tract. In a recent clinical study, researchers followed 84 people who used a Medtronic SynchroMed system. The success rate of the procedure was found to be 86%.
• Acupuncture – Used for pain reduction, this Chinese therapy involves the insertion of fine needles into the skin and muscle. The practitioner guides the needles onto meridians, which are body regions that control pain. This therapy is used for pain control and to restore normal energy flow. In a systematic review of several randomized controlled studies, where acupuncture was used for chronic pain, researchers analyzed almost 18,000 patients. The found that pain scores were reduced after acupuncture therapy. They concluded that acupuncture was an effective treatment for chronic pain.

Resources

Corrado P, Alperson B, & Wright M (2008). Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients. Neuromodulation, 11(2), 98-102.

Gamal G, Helaly M, & Labib YM (2006). Superior hypogastric block. transdiscal versus classic posterior approach in pelvic cancer pain Clin J Pain, 22:544-547.

Heading RC (1999). Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. Scand J Gastroenterol Suppl, 231:3–8.

Levy M & Wiersema M (2012). Endoscopic ultrasound-guided celiac plexus and ganglia interventions. Retrieved from UpToDate.

Vickers, AJ, Cronin AM, Maschino AC, et al. (2012). Acupuncture for chronic pain. Arch Intern Med,172(19):1444-1453. doi:10.1001/archinternmed.2012.3654.