Abdominal and Pelvic Pain
Chronic abdominal pain can be a distressing condition which, on occasion may have no discernible cause in spite of repeated investigations-“ all normal”. In other cases, there could be some organ involvement like in chronic pancreatitis, where the pain and suffering can be severe and specific treatment strategies are needed.
The many causes of Chronic abdominal pain :
Chronic Pancreatitis Irritable bowel syndrome Dyspepsia and upper abdominal pain Pain from the gall bladder, like Gallstones- Cholelithiasis Pain from the Kidney, like renal stones- Nephrolithiasis Cancer pain from cancer stomach, pancreas, liver ,uterus ovary etc Post surgery pains- post hernia surgery pain Simple pains referred from the abdominal wallTreatment:
Treatment is holistic, with medications and a number of Interventional procedures that can be performed when necessary, in the operation theatre. The nerve supply to the abdominal organs comes from 2 sources,
1. The vagus nerve
2. The splanchnic nerves which join together to form the celiac plexus which in turn supplies the organs, This is mainly responsible for the pain
Interventions are ,Celiac plexus block, Interlaminar Epidural analgesia ( blocking the nerves at the spinal cord before they become the splanchnic nerves . In recalcitrant cases radiofrquency ablation of the splanchnic nerves that make up the celiac plexus.
This is supported in the acute and the rehabilitative phase by medications IMS and Physical therapy , advice of dietary modification, lifestyle changes, etc.
CHRONIC PELVIC PAIN
• Chronic prostatitis
• Interstitial cystitis
• Pain associated with periods.
All these are pains associated with a sensitive part of anatomy. Patients seek help only when the pain becomes troublesome. Urologists and gynaecologists look for an organic reason for the pain which may or may not be there. Organic problems are best addressedby these specialists and pain specialist have to work with them. However the whole or part of the problem is in the nervous system. Adressing this is like trying to unravel a horribly knotted skein of woolen thread. As one problem is solved another underlying problem comes to the surface. So much so 1 month down the treatment the initial problem may be totally absent but some other complaint may come up. Patiently listening to the patient and trying to understand what the symptoms are trying to tell us invariably leads to its resolution sooner or later. For this the pain specialist has to have patience and the patient trust in the doctor. Both have been in abundance in our practice at Ashirvad who have taught us so much about these conditions that are just not there in any text book or journal article. We have been indeed privileged to have treated these valiant people. We have gone back to the dawn of medicine in Interstitial cystitis patients whose history and ongoing reports have taught us the basics of this problem rather than any investigation or literature.
The gist of our experience has been that medications, continuous blocks, botox injections into the pelvic musculature and target specific pelvic physiotherapy can end these terrible pains for life.