Abdominal Pain
 

Abdominal Pain

What is chronic abdominal pain?

Abdominal pain is common and occurs to most people on occasion. It usually occurs for a brief period of time and can have many benign causes, such as indigestion. Sometimes, such as when having appendicitis, it is serious and requires the attention of a healthcare provider. Abdominal pain can also become chronic. Healthcare providers consider it chronic when it last longer than six months.

 

Is there a cure for chronic abdominal pain?

Chronic abdominal pain is often identified as a problem in the gastrointestinal, endocrine, or reproductive systems of the body. However, these problems commonly have no identifiable cause.  An example is chronic pancreatitis. Healthcare providers are able to identify that the pancreas is part of the problem but are often unable to understand why it is happening. Conditions, like chronic pancreatitis, that have no identifiable cause are called ‘idiopathic.’

 

Most patients with idiopathic chronic abdominal pain have had numerous tests and procedures.  Common tests are the following:

 

  • MRI scans

  • CT scans

  • Endoscopies

  • Colonoscopies

  • Blood, urine and fecal tests

  • Endoscopic retrograde cholangiopancreatographies (ERCP’s)

  • Magnetic resonance cholangiopancreatographies (MRCP’s)

  • Ultrasound

These tests are ways to assess the health and functioning of the different bodily systems that lie in the abdomen, such as the gastrointestinal and reproductive systems. It is important to rule-out potential causes of pain in these systems, such as cancers, endometriosis, Crohn’s disease, irritable bowel syndrome, among others. Oftentimes, as indicated, the cause of chronic abdominal pain remains unknown.

 

Therapies & Procedures for chronic abdominal pain

Similarly, patients with idiopathic chronic abdominal pain often have had numerous procedures that fail to cure the condition. When a cause is not readily identifiable, recommendations for therapies and procedures tend to get made on a trial-and-error basis. Patients with chronic abdominal pain commonly have had multiple procedures and surgeries. Examples are the following:  

 

  • Appendectomies

  • Cholecystectomies (i.e., removal of the gall bladder)

  • Oopherectomies (i.e., removal of the ovaries)

  • Hysterectomies

  • Ablations

  • Stent insertions

  • Biliary and pancreatic sphincterectomies

  • Scar tissue removal

  • Exploratory surgeries

Pursuit of these procedures assumes that the primary cause of pain is some problem in the gastrointestinal, endocrine, or reproductive system. Patients and their healthcare providers tend to try one after another in attempt to cure the pain condition. These procedures are often worth trying, particularly in the acute phases of having abdominal pain. However, they are often unsuccessful once pain has become chronic.  

 

It is well-established that central sensitization is a factor in chronic abdominal pain. Dengler-Crish, C. M., Bruehl, S., & Walker, L. S. (2011). Increased wind-up to heat pain in women with a childhood history of functional abdominal pain. Pain, 152, 802-808. Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152, S2-S15. Central sensitization is a highly reactive state of the nervous system, which amplifies pain. It can occur with any pain disorder, including chronic abdominal pain. It is not known whether central sensitization can be an initial cause of abdominal pain or whether it is a secondary cause, which maintains abdominal pain on a chronic course. Either way, it is important to address in treatment.  

 

Chronic pain rehabilitation programs focus on reducing the central sensitization associated with any type of chronic pain condition, including chronic abdominal pain. They are an intensive, interdisciplinary approach that combines lifestyle changes, coping skills training, and medication management. The overall goal of these treatment approaches is to reduce central sensitization by down-regulating the nervous system. The original problem in the gastrointestinal or reproductive system that initially caused the pain may remain unresolved or unknown. However, by reducing central sensitization, pain is reduced to tolerable levels.  

 

There is hope even if the original cause of pain remains unknown. There is hope even if there is no cure.

 

Author

Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain. The Institute for Chronic Pain is an educational and public policy think tank. Its purpose is to bring together thought leaders from around the world in the field of chronic pain rehabilitation and provide academic-quality information that is also approachable to all the stakeholders in the field: patients, their families, generalist healthcare providers, third party payers, and public policy analysts. Its aim is to change the culture of how chronic pain is managed through education and consultation efforts that advocate for the use of empirically supported conceptualizations and treatments of chronic pain. He also blogs at the Institute for Chronic Pain Blog.

 

References

Last Updated on Monday, 26 December 2016 19:11

Published on Friday, 27 April 2012 13:34

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