Chronic Abdominal Pain: Neurological Connections and Diagnosis

Long-term.?

I apologize for bothering you again with the following questions.
I have been experiencing thigh and abdominal pain for a long time.
The abdominal pain is characterized by cramping, bloating, and colicky sensations.
It starts from the lower back on both sides and extends to the middle of the ribs, accompanied by a feeling of pressure.
There is also a vague discomfort that is hard to describe.
Additionally, I bruise easily without any apparent cause (the bruises are purple and red).
Sometimes, I experience sudden sharp pains that feel like they are coming from either the muscles or the skin, and occasionally, I have a nerve-like sharp pain sensation.
At times, the pain radiates from the pelvic area to the abdomen, thighs, vagina, and anus, but these episodes are brief.
These symptoms have persisted for over a year.
I have consulted a gynecologist, undergone internal examinations, and had ultrasounds, all of which showed no issues.
I also had urine tests and kidney and bladder ultrasounds with no findings.
Gastroenterology evaluations, including gastroscopy, barium enema X-rays, liver and gallbladder ultrasounds, and stool tests, all returned normal results.
Consequently, the gastroenterologist diagnosed me with irritable bowel syndrome, but after taking medication for over a year, there has been no improvement.
I would like to ask if the thoracolumbar nerves or nerve plexus could also cause abdominal pain? If so, how can these nerves or plexus be examined?

Double W, 10~19 year old female. Ask Date: 2012/08/28

Dr. Gao Chunde reply Neurology

The thoracolumbar nerves and the lumbar or sacral plexus primarily provide sensation to the back, abdominal wall, buttocks, perineum, and lower limbs.
Visceral pain from abdominal pain is typically mediated by the vagus nerve.
Diagnostic imaging options include magnetic resonance imaging (MRI) and computed tomography (CT), but these advanced imaging studies will only be covered by health insurance if deemed necessary after a thorough examination by a neurologist.

Reply Date: 2012/08/28

More Info

Chronic abdominal pain can be a complex issue, often involving multiple systems in the body, including the gastrointestinal, musculoskeletal, and neurological systems. Your symptoms, which include abdominal pain that feels like cramping, pressure, and discomfort, along with bruising and sudden sharp pains, suggest that there may be a neurological component to your condition.
The abdominal pain you describe, radiating from the lower back to the ribs and accompanied by sensations in the thighs and pelvic area, could indeed be related to nerve involvement. The thoracolumbar nerves, which originate from the thoracic and lumbar spine, innervate the abdominal wall and can influence sensations in the abdominal region. Conditions such as nerve compression, neuropathy, or even referred pain from other areas can manifest as abdominal discomfort.

Given that you've undergone extensive testing with negative results, including gynecological exams, ultrasounds, and gastrointestinal evaluations, it’s understandable that you’re seeking further insight. The diagnosis of irritable bowel syndrome (IBS) by your gastroenterologist indicates a functional gastrointestinal disorder, which can be exacerbated by stress and anxiety. Chronic stress and anxiety can lead to heightened sensitivity to pain and discomfort, potentially worsening your perception of abdominal pain.

Regarding your question about the thoracolumbar nerves and their potential role in your abdominal pain, yes, these nerves can indeed contribute to abdominal pain through a phenomenon known as referred pain. This occurs when pain is perceived in an area different from its source due to the way nerves are interconnected. For example, irritation or injury to the nerves in the lumbar region can lead to pain that feels like it originates from the abdomen.

To evaluate the thoracolumbar nerves, several diagnostic methods can be employed:
1. Magnetic Resonance Imaging (MRI): This imaging technique provides detailed images of the spine and can help identify any structural abnormalities, such as herniated discs or spinal stenosis, that may be compressing the nerves.

2. Computed Tomography (CT) Scan: Similar to MRI, a CT scan can provide cross-sectional images of the spine and surrounding structures, helping to identify any issues that may be affecting nerve function.

3. Nerve Conduction Studies (NCS) and Electromyography (EMG): These tests assess the electrical activity of nerves and muscles, helping to identify any peripheral nerve dysfunction that may be contributing to your symptoms.

4. Physical Examination: A thorough neurological examination by a specialist can help identify any signs of nerve involvement, such as reflex changes or sensory deficits.

5. Consultation with a Neurologist: Given your symptoms and the complexity of your case, a referral to a neurologist may be beneficial. They can perform a detailed assessment and determine if further testing is warranted.

In conclusion, while your abdominal pain may have a gastrointestinal origin, the involvement of the thoracolumbar nerves cannot be ruled out. It is essential to continue working with your healthcare providers to explore all potential causes of your symptoms. Addressing any underlying anxiety or stress through counseling or therapy may also help alleviate some of the discomfort you are experiencing. Remember, chronic pain is multifaceted, and a comprehensive approach is often necessary for effective management.

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