FAQ’s on Abdominal Pain Treatment in Philadelphia

 

Pain of the abdomen is an uncomfortable experience that every person goes through at some point in time. However, for some individuals abdominal pain can be of a chronic nature (lasting longer than three months). Chronic abdominal pain can become disruptive to normal life, particularly due to severity or frequency.

What causes chronic abdominal pain?

Many conditions cause chronic abdominal pain. Common causes include:

  • Chronic pancreatitis – This disorder involves frequent inflammation of the pancreas and biliary tree.
  • Diverticulitis – When the small sacs in the large intestine lining become inflamed, the condition causes abdominal pain.
  • Gastroesophageal reflux disease (GERD) – With this condition, the stomach produces more acid than normal.
  • Gastritis – This is chronic inflammation of the stomach lining.
  • Inflammatory bowel disease – These conditions include ulcerative colitis and Crohn’s disease.
  • Irritable bowel syndrome (IBS) – With this condition, the patient has abdominal discomfort, constipation, diarrhea, and cramping.

What other conditions are associated with chronic abdominal pain?

Conditions associated with chronic abdominal pain include renal calculi, endometriosis, congenital abnormalities, ovarian cysts, ovarian cancer, renal calculi, chronic pyelonephritis, fibroids, herpes zoster, hepatitis, and radiculitis.

How common is chronic abdominal pain?

Chronic abdominal pain is discomfort that persists for more than three months, either intermittently or continuously. This pain affects around 2 percent of adults, mainly women. Most people with chronic abdominal pain have other chronic gastrointestinal symptoms.

What are the risk factors for chronic abdominal pain?

Chronic abdominal pain often occurs without a cause. It can be brought on by a stressful event, such as death of a loved one, abuse, or divorce, or it can result from an injury to the abdomen from surgery or trauma.

How does the doctor diagnose chronic abdominal pain?

When you visit the doctor, he/she is concerned with discovering the underlying cause of abdominal pain. The doctor will take a history of your medical problem and conduct a comprehensive physical examination. In addition, the doctor will order certain diagnostic tests. These include laboratory evaluations, computed tomography scans, ultrasounds, and x-rays.

What are the treatment options for chronic abdominal pain?

Depending on the cause of chronic abdominal pain, treatment focuses at alleviating the pain and associated symptoms. Options of treatment include:

  • Celiac plexus block – Used for chronic pancreatitis and abdominal cancer pain, this block involves insertion of a small needle into the back using x-ray guidance. The celiac plexus nerves supply the abdominal organs and structures, and instilling a long-acting anesthetic onto these nerves stops pain signal transmission. In a recent clinical study, researchers reported that this block had an efficacy rate of 90%.
  • Superior hypogastric plexus block – With this procedure, the superior hypogastric plexus nerves are targeted. The doctor inserts a needle into the back to inject an anesthetic agent onto these nerves. According to researchers, this block has a success rate of around 72%, with effects lasting for up to six months.
  • Neurolysis – When a block proves effective, the doctor may choose to inject a neurolytic agent onto the nerves, which destroys a portion of the nerve root. Agents used include phenol and ethanol, which are injected using fluoroscopy guidance to assure correct needle position. A recent pilot study showed that this procedure has a 90% success rate.
  • Patient controlled analgesia (PCA) – With long-standing chronic abdominal pain, the pain specialist often recommends PCA. The patient receives strong pain medicine intravenously. The patient controls how much medication he/she receives, as well as when the dose is given.

Resources

Eisenberg E, Carr DB, & Chalmers TC (1995). Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesthesia Analgesia, 80:290-295.

McGreevy K, Hurley RW, Erdek MA, Aner MM, Li S, & Cohen SP (2013).The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Practice,13:89–95.

Plancarte R, de Leon-Casasola OA, El-Helealy M, et al.(1997). Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Regional Anesthesia, 22:562-568.

Rosenberg SK, Tewari R, Boswell MV, et al. (1998). Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate. Regional Anesthesia Pain Medicine, 23:618-620.