Chronic Abdominal Pain is abdominal pain that persists for an extended period, typically for at least 3–6 months. The pain may be intermittent or continuous.
The Chronic Abdominal Pain Department at Sapiens Hospital provides diagnosis and treatment for patients with chronic abdominal pain, which can arise from many different causes, including gastrointestinal disorders, urinary tract conditions, neurological problems, or even abdominal muscle disorders. The doctor will take a detailed medical history, perform a physical examination, and consider additional investigations to identify the underlying cause before developing a treatment plan. The most effective treatment is directed at the underlying cause rather than simply providing temporary symptom relief. If the pain does not respond to initial treatment, a pain specialist may consider more advanced treatment approaches to achieve better pain control.
Causes of Chronic Abdominal Pain
1. Gastrointestinal Conditions
- Peptic Ulcer Disease may cause burning pain in the upper or central abdomen, particularly when the stomach is empty.
- Gastroesophageal Reflux Disease (GERD) may cause heartburn, abdominal discomfort, and acid regurgitation.
- Irritable Bowel Syndrome (IBS) commonly causes abdominal cramping associated with changes in bowel habits.
- Inflammatory Bowel Disease (IBD), such as Crohn’s Disease and Ulcerative Colitis, may cause abdominal pain, chronic diarrhea, and weight loss.
- Gallstones may cause pain in the upper right abdomen, particularly after eating high-fat meals.
2. Muscle and Nerve-Related Pain
- Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES) occurs when nerves in the abdominal wall become compressed, causing localized pain that may feel burning, sharp, or stabbing.
- Myofascial Pain Syndrome of the abdominal muscles can result from trigger points in the muscles and may cause referred pain to other areas.
- Neuropathic Pain may result from nerve abnormalities, such as after abdominal surgery or in patients with diabetes.
3. Urinary Tract Conditions
- Kidney Stones can cause severe cramping pain in the back or side of the abdomen that may radiate to the groin.
- Urinary Tract Infection (UTI) may cause lower abdominal or back discomfort together with painful or burning urination.
- Interstitial Cystitis may cause chronic lower abdominal or pelvic pain, particularly in relation to urination.
- Pyelonephritis can cause pain in the lower back or side of the abdomen together with high fever and chills.
4. Other Conditions
- Endometriosis occurs in women and may cause chronic lower abdominal pain and severe menstrual pain.
- Hernia may cause pain associated with pressure or protrusion of internal tissues or organs.
- Abdominal cancers such as pancreatic cancer, stomach cancer, or ovarian cancer may also cause persistent abdominal pain.
Diagnostic Evaluation
- Blood tests to evaluate inflammation, infection, anemia, or other abnormalities.
- Abdominal Ultrasound to evaluate conditions such as gallstones, kidney abnormalities, and other abdominal organs.
- CT Scan and MRI to evaluate abnormalities of internal organs when clinically indicated.
- Endoscopy / Colonoscopy to examine the gastrointestinal tract for conditions such as peptic ulcers or inflammatory bowel disease.
- Urinalysis to look for urinary tract infection, blood in the urine, or abnormalities related to kidney stones.
- Nerve Block Test may be used in selected patients to assess whether a specific nerve contributes to the pain by injecting local anesthetic around the suspected nerve.
Treatment Approaches
1. Medication
- Acid-suppressing medicines such as PPIs or H2 blockers for appropriate gastrointestinal conditions.
- Anti-inflammatory medicines such as NSAIDs or other pain-relieving medications.
- Antispasmodic medications for selected patients with conditions such as IBS.
- Neuropathic pain medications such as Gabapentin, Pregabalin, or Mirogabalin for nerve-related pain.
- Antidepressant medications such as Tricyclic Antidepressants (TCAs) or Duloxetine may be considered for selected chronic neuropathic pain conditions.
- Antibiotics for urinary tract infections when clinically indicated.
2. Physical Therapy and Lifestyle Modification
- Exercises to strengthen the abdominal muscles.
- Myofascial Release techniques to reduce pain associated with trigger points.
- Breathing exercises and yoga may help reduce stress that can influence chronic pain.
3. Pain Intervention
- Trigger Point Injection using local anesthetic or selected medication at painful trigger points in the abdominal muscles.
- Nerve Block Injection around selected nerves to reduce pain related to ACNES or neuropathic pain.
- Radiofrequency Ablation (RFA) uses radiofrequency energy to modify pain signals from selected nerves in appropriately evaluated patients.
- Botulinum Toxin Injection may be considered in selected patients with chronic muscle spasm or specific pain conditions.
The most effective approach to chronic abdominal pain is to identify and treat the underlying cause rather than only providing temporary pain relief. If symptoms do not respond to initial treatment, consultation with an appropriate specialist is recommended for further evaluation and treatment.
Chronic Abdominal Pain Department Services
- Nerve injections for pain relief for selected patients whose pain is associated with nerve compression or inflammation.
- Spinal Cord Stimulation may be considered in carefully selected patients with severe chronic neuropathic pain that has not responded adequately to other treatments.
- Radiofrequency Ablation (RFA) may be used in selected pain conditions to reduce pain signals from specific nerves without major surgery.
Frequently Asked Questions (FAQ)
1. When is abdominal pain considered chronic, and when should I see a specialist?
If abdominal pain persists continuously or repeatedly for approximately 3–6 months or longer, it may be considered chronic abdominal pain and should be evaluated to determine the underlying cause rather than repeatedly treating only the symptoms.
2. All of my tests are normal, but I still have abdominal pain. How is this possible?
Some chronic abdominal pain does not arise directly from internal organs. It may originate from the abdominal wall, muscles, or nerves, such as ACNES or Myofascial Pain Syndrome. These conditions may not be detected by routine blood tests or ultrasound and may require a specialized clinical evaluation or diagnostic nerve block.
3. What is a Trigger Point Injection, and who may benefit from it?
A Trigger Point Injection involves injecting medication into a specific painful area within a muscle. It may be considered for selected patients with Myofascial Pain Syndrome who have clearly identifiable trigger points and referred muscular pain.
4. Does chronic abdominal pain always require surgery?
No. Treatment depends on the underlying cause. Many patients can be treated with medication, physical therapy, or non-surgical pain interventions such as nerve blocks or radiofrequency procedures. Surgery may be necessary when a specific surgical condition is identified, such as certain hernias or symptomatic gallstones.
5. Which diagnostic test should be performed first?
The doctor generally begins with a detailed history and physical examination. Blood tests, urine tests, ultrasound, CT Scan, MRI, or endoscopy may then be selected according to the patient’s symptoms and suspected cause rather than using the same test sequence for every patient.
