Chronic Abdominal Pain

27th November 2006 at 10:24 GMT by Dr.C.A.Jenner MB BS, FRCA. Permalink.

Article on the clinical features and treatment of Chronic Abdominal Pain

Introduction

Abdominal pain is essentially defined as a sensation of discomfort, distress or agony in the abdominal region, generally associated with functional disorders, tissue injuries and diseases.

The abdomen is an anatomical area, bounded by the lower margin of the ribs above, the pelvic bone (pubic ramus) below and the flanks on each side.

The term ‘abdominal pain’ is also generally used to refer to the pain that originates from organs within the abdominal cavity (from beneath skin and muscles), including the stomach, small intestine, colon, liver gallbladder and pancreas.

A pain in abdomen is termed as ‘chronic abdominal pain’ if it lasts for more than 6 months.

Subcategories of Pain

Pain in the abdomen can be further classified in to various subcategories, including:

1. Stomach cramps
2. Stomach ache
3. Heartburn
4. Liver pain
5. Acute abdominal pain
6. Chronic Abdominal Pain in children

Chronic abdominal pain in children is defined as a pain of more than two weeks duration. The pain might be persistent or recurrent and the intensity varies with age, gender, genetic predisposition, nutritional exposure and many environmental factors.

This type of pain is a common pediatric problem encountered by primary care physicians, medical subspecialists and surgical specialists. According to the International Foundation for Functional Gastrointestinal Disorders, this syndrome causes a vast number of children to miss more schooldays, suffer social withdrawal and feel anxious and depressed about their condition.

Especially in children, there are a series of warning signs to look for. Immediate medical intervention should be sought if any of the below seem to exist:

• Severe abdominal pain that wakes up the child at night
• Persistent vomiting
• Fever
• Weight loss
• Having bloody stools or vomiting blood

Key Symptoms

A series of symptoms indicate that the abdominal pain is chronic in nature. Here we list the few main symptoms of chronic abdominal pain:

• Pain that becomes worse with eating
• Pressure in the abdomen when you lie down at night
• Pain relief after having antacids
• Sharp pangs of pain brought on by greasy or fatty foods
• Repetitive and alternate episodes of loose and hard bowel movements
• Diarrhea-like bowel movements mixed with mucus and blood
• Recurrent bouts of pain with fever
• Loss of appetite

Causative Factors

Chronic abdominal pain is most commonly caused by a series of gastrointestinal causes. Here we list a few main ones amongst these causes:

• Loss of appetite
• Peptic ulcers
• Chronic pancreatitis
• Gastroesophageal reflux disease
• Dyspepsia
• Gallbladder disease
• Irritable bowel syndrome
• Inflammatory bowel disease

However, chronic abdominal pain also might be the result of certain uncommon and rare causes, often difficult to diagnose. These include:

• Abdominal wall pain
• Fibromyalgia (Myofacial Pain Syndrome)
• Painful rib syndrome
• Tietze’s syndrome
• Posttraumatic pain
• Hernia
• Thoracic disk herniation
• Spinal-muscle or vertebral-body disorder
• Metabolic disease
• Psychological disorder

Treatment Strategies

The aim of a treatment plan for chronic abdominal pain is to help gain control over the symptoms and improve daily life efficiency. Various forms of treatment adopted include:

• Medications (painkillers and antidepressants)
• Surgical procedures
• Psychological counseling