Persistent Pain After Gallbladder Removal: Seeking Answers and Solutions

Pain after gallbladder removal?

Hello doctor, I have been experiencing discomfort and pain in my stomach and back since 2011, which has been severe enough to cause me to double over in pain.
It wasn't until 2013 that I was diagnosed with gallstones and underwent traditional surgery to have them removed.
After the surgery, I continued to experience intermittent pain that would lead me to the emergency room for pain relief.
Sometimes my blood tests show normal results, while other times my GOT and GPT levels are significantly elevated.
I have visited many hospitals and undergone numerous tests, all of which have returned normal results.
However, each time I undergo an endoscopy, I consistently have mild ulcers or gastritis along with bile reflux.
The pain typically starts in the middle of my stomach and radiates to both sides of my ribcage and up to my upper back.
Recently, the frequency of these episodes has increased.
I went for a full-body check-up, but the night before the exam, I experienced pain again and had to go to the emergency room for pain relief.
The next day, after the check-up, the report indicated gastritis and bile reflux, with GOT at 206 and GPT at 120, while other results were normal.
The doctor believes that the elevated levels are due to my stomach issues, but they shouldn't cause such severe pain, so I was referred to a neurologist who suggested it might be autonomic nervous system dysfunction.
I have been taking stomach medications and pain relievers for over six years and have visited many outpatient clinics, but the pain medications are becoming less effective.
I am unsure which specialty I should consult next and am increasingly losing confidence that this will ever improve.

Nìmíng, 20~29 year old female. Ask Date: 2017/09/24

Dr. Cai Jinji reply Gastroenterology and Hepatology

It is recommended to consult a gastroenterologist for examination.

Reply Date: 2017/09/24

More Info

Persistent pain after gallbladder removal, also known as post-cholecystectomy syndrome, can be a challenging condition to manage. It is understandable that you are feeling frustrated and confused after experiencing ongoing pain and discomfort despite undergoing surgery and numerous medical evaluations. Let's break down your situation and explore potential avenues for relief.

1. Understanding Post-Cholecystectomy Syndrome: After gallbladder removal, some patients may continue to experience abdominal pain, digestive issues, or other symptoms. This can be due to several factors, including bile duct injury, retained gallstones, or changes in bile flow. Additionally, the surgery itself can lead to alterations in the digestive process, which may contribute to symptoms like gastritis or bile reflux.

2. Symptoms and Diagnosis: Your description of pain radiating from the stomach to the sides and back, along with episodes of nausea and the presence of gastritis and bile reflux, suggests that your digestive system is still struggling to adapt post-surgery. The elevated liver enzymes (GOT and GPT) could indicate liver stress or inflammation, possibly linked to your ongoing gastrointestinal issues.

3. Role of the Autonomic Nervous System: The mention of autonomic nervous system dysregulation is significant. The autonomic nervous system controls involuntary bodily functions, including digestion. Stress, anxiety, and chronic pain can all impact this system, potentially exacerbating your symptoms. This could explain why traditional pain management strategies have become less effective over time.

4. Multidisciplinary Approach: Given the complexity of your symptoms, a multidisciplinary approach may be beneficial. This could involve:
- Gastroenterology: A gastroenterologist can help manage your digestive symptoms, potentially adjusting your medications or exploring other treatments like dietary changes or probiotics.

- Pain Management: A pain management specialist can provide alternative therapies, such as nerve blocks, physical therapy, or acupuncture, which may help alleviate chronic pain.

- Psychological Support: Since chronic pain can lead to anxiety and depression, working with a psychologist or psychiatrist may help you develop coping strategies and address any underlying emotional factors contributing to your pain.

5. Lifestyle Modifications: In addition to medical interventions, consider lifestyle changes that may improve your symptoms:
- Diet: A low-fat diet may help reduce bile reflux and digestive discomfort. Keeping a food diary can help identify any specific triggers.

- Stress Management: Techniques such as mindfulness, yoga, or meditation can help manage stress, which may positively impact your symptoms.

- Regular Exercise: Gentle exercise can improve overall well-being and may help alleviate some pain.

6. Follow-Up and Persistence: It is crucial to maintain open communication with your healthcare providers. If you feel that your concerns are not being adequately addressed, do not hesitate to seek second opinions or consult specialists who focus on chronic pain or functional gastrointestinal disorders.

In conclusion, while it may feel overwhelming, there are various avenues to explore for managing your persistent pain after gallbladder removal. A comprehensive approach that includes medical treatment, lifestyle modifications, and psychological support can significantly improve your quality of life. Remember, you are not alone in this journey, and with persistence and the right support, it is possible to find relief.

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