Chronic Abdominal Pain: Seeking the Right Specialist for Relief

Q: Chronic Abdominal Pain: Seeking the Right Specialist for Relief

● The causes of abdominal pain are diverse： (1) Hepatobiliary and gastrointestinal： gastritis, enteritis, peptic ulcers, inflammatory bowel diseases (ankylosing spondylitis may be associated with inflammatory bowel diseases such as ulcerative colitis and Crohn's disease), diverti

Abdominal pain for two years, with reduced discomfort when lying down?

Doctor, the gastroenterologist said that all my internal organs are normal, so it shouldn't be an organ issue.
However, I have been experiencing persistent abdominal pain that doesn't feel deep inside.
No pain medication seems to work, and even injections have no effect; lying down is the only position that provides some relief.
Recently, I have been feeling increasingly uncomfortable, and even lying down feels somewhat wrong.
I have Parkinson's disease and ankylosing spondylitis, and I don't take my spinal medication regularly, but I don't usually feel any back pain.
Due to the abdominal pain, I have been hunching over.
Which specialty should I consult?

Mr. Chen, 50~59 year old female. Ask Date: 2017/08/01

Dr. Chen Taicheng reply Family Medicine

● The causes of abdominal pain are diverse: (1) Hepatobiliary and gastrointestinal: gastritis, enteritis, peptic ulcers, inflammatory bowel diseases (ankylosing spondylitis may be associated with inflammatory bowel diseases such as ulcerative colitis and Crohn's disease), diverticulitis, irritable bowel syndrome, severe constipation, vascular ischemia, hepatitis, pancreatitis, gallstones, cholecystitis, etc.
(2) Urological: urinary tract stones or tumors, etc.
(3) Other causes such as immune-mediated vasculitis, uremia, diabetic ketoacidosis, porphyria, abdominal aortic aneurysm, or dissection, among others.
Many internal and external medical conditions can lead to abdominal pain.
● It is recommended to first determine whether the medications you are taking could cause abdominal pain or ulcers; additionally, consult a gastroenterologist to rule out issues related to the stomach, duodenum, and colon (including inflammatory bowel diseases) as well as hepatobiliary and pancreatic problems → then see a urologist to exclude urinary issues → and for other concerns, consult internal medicine or family medicine for further evaluation.
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department cares about you~

Reply Date: 2017/08/01

More Info

Chronic abdominal pain can be a complex issue, especially when the underlying cause is not immediately apparent. Given your situation, where gastroenterology has ruled out any organ-related problems, it’s essential to consider other potential causes and the interplay of your existing conditions, such as Parkinson's disease and ankylosing spondylitis.

Firstly, it’s crucial to understand that abdominal pain can stem from various sources, including gastrointestinal, musculoskeletal, neurological, and even psychological factors. Since your gastroenterologist has indicated that your internal organs appear normal, it may be beneficial to explore other avenues.

1. Musculoskeletal Issues: Given your history of ankylosing spondylitis, which primarily affects the spine and can lead to stiffness and pain, it’s possible that your abdominal pain could be related to musculoskeletal issues. The chronic pain and postural changes associated with your condition may lead to referred pain in the abdominal area. Consulting with a rheumatologist who specializes in inflammatory conditions could provide insights into whether your spinal issues are contributing to your abdominal discomfort.

2. Neurological Factors: Parkinson's disease can lead to various gastrointestinal symptoms, including abdominal pain, due to autonomic dysfunction. This dysfunction can affect gut motility and lead to conditions such as gastroparesis, which can cause discomfort and pain. A neurologist familiar with Parkinson's disease may help assess whether your symptoms are related to your neurological condition.

3. Pain Management Specialist: Since you have tried various pain relief methods without success, consulting a pain management specialist could be beneficial. They can offer a multidisciplinary approach to pain management, which may include medications, physical therapy, and other interventions tailored to your specific needs.

4. Physical Therapy: Engaging in physical therapy may help address any postural issues stemming from your conditions. A physical therapist can work with you to improve your posture, strengthen your core muscles, and potentially alleviate some of the abdominal pain by addressing musculoskeletal imbalances.

5. Psychological Factors: Chronic pain can also have psychological components. Anxiety and depression can exacerbate pain perception. If you find that your pain is affecting your mental health, it may be worth consulting a psychologist or psychiatrist who specializes in chronic pain management.

6. Gastroenterology Follow-Up: Although your gastroenterologist has ruled out organ-related issues, it might be worthwhile to revisit them, especially if your symptoms have worsened. They may consider additional tests, such as imaging studies or gastrointestinal motility studies, to further investigate the cause of your pain.

In summary, given your complex medical history, it may be beneficial to take a multidisciplinary approach. Start by consulting a rheumatologist for your ankylosing spondylitis, a neurologist for your Parkinson's disease, and a pain management specialist to explore comprehensive pain relief strategies. Additionally, consider physical therapy to address any musculoskeletal issues and a mental health professional if you feel your psychological state is impacting your pain experience. This comprehensive approach may help identify the underlying causes of your chronic abdominal pain and lead to more effective management strategies.

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