Chronic abdominal pain: What are the causes, and how is it treated?

Chronic abdominal pain, felt anywhere in the area between the thorax and the pelvis, is a concern that especially affects young adult women.

Here to provide an expert insight into chronic abdominal pain, including causes and treatment, is Dr Rajesh Menon, renowned consultant in anaesthetics and pain management.

What is considered chronic abdominal pain?

Chronic abdominal pain refers to constant or intermittent discomfort in the abdomen that lasts for more than six months. Around 0.6 - 2.2 per cent of patients with abdominal pain will go on to develop chronic abdominal pain in the future.

In many cases, chronic abdominal pain will be aggravated by a viscerosomatic convergence of: referred pain, which is pain that radiates to a location in the body other than the site of pain; central sensitisation, which describes hypersensitivity to pain; and persistent neuroplasticity, which is the brain’s ability to change and adapt.

What can cause long-term, chronic abdominal pain?

There are numerous causes for chronic abdominal pain, including:

• Gastrointestinal causes: Chronic abdominal pain can be caused by chronic pancreatitis and inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis.

• Urogenital causes: Chronic abdominal pain can occur due to neoplasms (abnormal tissue growth), cysts, varicoceles (enlarged veins in the scrotum), prostatitis (a prostate gland disorder), interstitial cystitis (bladder pain syndrome) and chronic pelvic pain. As well as this, chronic abdominal pain can also arise following a vasectomy procedure.

• Gynaecological causes: Chronic abdominal pain can be caused by adhesions (scar-like tissue), endometriosis, pelvic congestion syndrome (enlarged pelvic veins) and polycystic ovary syndrome. In addition, chronic abdominal pain can also develop after hysterectomy, Caesarean and cancer treatment procedures.

• Neurological causes: Chronic abdominal pain can be caused by fibromyalgia, chronic abdominal pain that is felt by the brain’s somatosensory cortex, nerve entrapment within the abdominal cavity (such as, anterior cutaneous nerve entrapment syndrome) and myofascial pain syndromes (such as, amplified musculoskeletal pain syndromes) that affect muscles and soft tissues.

• Metabolic causes: Chronic abdominal pain can occur due to porphyria (disorders that affects the skin and the nerves), diabetic retinopathy and alcohol intake.

• Psychological causes: Chronic abdominal pain has been associated with PTSD, anxiety, depression and personality disorders, due to the impact of psychological distress on gut health.

• Musculoskeletal causes: Chronic abdominal pain can develop due to sacroiliac joint pain in the lower back, hip pain, symphysis pubic dysfunction (pain in the pelvic joints) and spinal pathologies.

• Functional causes: Chronic abdominal pain can also present without an apparent cause. Diagnostic tests may later reveal the cause to be functional dyspepsia, irritable bowel syndrome or functional abdominal pain syndrome.

How is chronic abdominal pain treated and relieved?

When it comes to chronic abdominal pain, a multidisciplinary approach to medical management is required. This is because treatment will depend on the cause of a patient’s chronic abdominal pain.

Following the input of a multidisciplinary team, and depending on the underlying cause for the chronic abdominal pain, specific interventions will be recommended.

These interventions may include:

• A transversus abdominis plane block (TAP): This is an injection of local anaesthetic, between the interna oblique and the transversus abdominis muscles of the abdominal wall, to produce a numbing effect on the nerves that pass through these muscles.

• A sympathetic nerve block: This is an injection of medication (commonly, steroids) to the sympathetic nerves in the spine to control chronic pain.

• Neuromodulation: This a new treatment that works directly on nerves. Using electrical stimuli or medication, neuromodulation therapies can alter nerve activity in a targeted area (for example, the abdomen) to improve pain.

• Psychological support: Mental health therapy can help to prevent the effects of stress and/or anxiety on the gut.

If a cause for chronic abdominal pain is not found, then treatment measures will focus on improving quality of life.

If you are living with chronic abdominal pain that does not seem to improve, do not hesitate to book an appointment with Dr Rajesh Menon via his Top Doctors profile today.