FAQs on Abdominal Pain Treatment

The abdomen is the body region below the ribs and right above the pelvic bone. The term “abdominal pain” refers to any pain that arises from the tissues, structures, and/or organs of the abdominal cavity, including the stomach, intestines, gallbladder, liver, spleen, and pancreas.

Sometimes, abdominal pain is acute (short-term), caused by conditions such as appendicitis, gastritis, and gastroenteritis. Other times, abdominal pain is chronic, occurring due to pancreatitis, peptic ulcer, or malignancy. According to hospital statistics, abdominal pain is the reason for 5% of all emergency department visits.

What is chronic abdominal pain?

Chronic abdominal pain (CAP) is pain that lasts for longer than three months, and it is a state of recurrent pain not due to organic, structural, or metabolic diseases. Also called functional abdominal pain syndrome (FAPS), CAP can occur intermittently or continuously.

This type of pain is unrelated to every day stimuli such as exercise, eating, defecation, or menstruation. Around 0.5% to 2% of adults suffer with CAP, which is more common among women (female to male ratio of 3:2).

What causes chronic abdominal pain?

While there is not exact cause of CAP, experts believe that sensory nerves of the spinal cord get excited and sensitive due to stress, depression, and other psychological factors. These factors contribute to efferent stimulation, which causes perception of pain even though not real underlying injury or disease is present.

How is abdominal pain diagnosed?

When a patient suffers with abdominal pain, the doctor will assess certain factors, including:

  • Severity and degree of pain
  • History of certain diseases like alcoholism, diabetes, and cirrhosis
  • Location of the pain
  • Changes in heart rate, blood pressure, and respiratory rate
  • Radiation of pain to back, shoulder, or groin
  • Presence of associated symptoms, such as diarrhea, vomiting, painful urination, etc.

Depending on symptoms and history findings, the doctor may order certain diagnostic tests for a patient with abdominal pain. These include blood tests to assess liver, blood, and kidney function, as well as imaging tests such as ultrasound, CT scan, or abdominal MRI. If necessary, stool and/or urine examination may be done along with electrocardiography (ECG) and arterial blood gases (ABG).

What are treatment options for abdominal pain?

Treatment of abdominal pain is aimed at the exact cause. For functional, chronic types of abdominal pain, treatment options include:

  • Medication Management – while not the optimal solution, pain medications may help tremendously for chronic abdominal pain. This may include NSAIDS, Tylenol, Tramadol or narcotics.
  • Celiac plexus block – With this procedure, the doctor places a small needle in the back under x-ray guidance (fluoroscopy). Contrast dye is injected to confirm placement of the needle near the celiac plexus (nerve mass associated with abdominal organs). The doctor injects a numbing agent near the plexus. In a recent meta-analysis study, approximately 90% of patients reported excellent pain relief during the first two weeks following the block.
  • Celiac plexus neurolysis – Often performed for chronic abdominal pain related to pancreatitis or cancer, this procedure is similar to the celiac plexus block. With neurolysis, the doctor injects a neurolytic substance (ethanol or phenol) to destroy the nerves of the celiac plexus. In one meta-analysis of patients with chronic abdominal pain, 90% reported relief of pain at 3 months post-procedure.
  • Superior hypogastric plexus block – In this procedure, the doctor inserts a needle into the back under x-ray guidance. After verifying position, a small amount of local anesthetic is injected onto the hypogastric plexus (nerve mass). In recent research studies, this block relieved abdominal and pelvic pain in 72% of patients for up to 6 months.
  • Patient controlled analgesia (PCA) – If a patient has long-standing CAP, a PCA pump may be recommended by the pain specialist. This involves the delivery of pain medication intravenously, with the patient having control of the time and dose of the medication.

Resources

Clouse RE, Mayer EA, Azia Q, Drossman DA, et al. (2006). Functional abdominal pain syndrome. Gastroenterology, 130(5), 1492-1497.

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

Kaufman M, Singh G, Das S, Concha-Parra R, Erber J, Micames C, & Gress F. (2010). Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterololgy, 44:127–134.

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. Reg 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. Reg Anesth Pain Medicine, 23:618-620.

Vorenkamp, KE & Dahle, NA (2011). Diagnostic celiac plexus block and outcome with neurolysis. Pain Management 15,(1), 28-32. DOI: http://dx.doi.org/10.1053/j.trap.2011.03.001