Chronic Abdominal and Lower Back Pain: Seeking Answers in Family Medicine

Lower back, abdomen

I have been experiencing abdominal pain along with discomfort in both lower back areas, extending about a hand's breadth both front and back, for over a year.
The pain is not constant in the abdomen, but the discomfort in the lower back is daily.
The lower back discomfort started after the abdominal pain began, which was not present before.
I have consulted specialists in gastroenterology, gynecology, urology, and allergy and immunology, but no issues were found.
The gastroenterologist diagnosed me with irritable bowel syndrome, but after taking medication for over a year, there has been no improvement in either the abdominal pain or the lower back discomfort.
Where else should I go for further evaluation?

Ru, 10~19 year old female. Ask Date: 2012/08/30

Dr. Liao Yaopan reply Family Medicine

Hello, based on your description, it is recommended to continue monitoring and follow-up examinations with the gastroenterology and gynecology departments.
Thank you for your message, and Changhua Hospital cares about you.

Reply Date: 2012/08/30

More Info

When dealing with chronic abdominal and lower back pain, especially in a case where multiple specialists have been consulted without a definitive diagnosis, it can be quite frustrating. Your description indicates a complex situation that may involve multiple systems in the body. Given that you have already seen specialists in gastroenterology, gynecology, urology, and rheumatology, and have been diagnosed with irritable bowel syndrome (IBS) without improvement, it may be time to consider a more holistic approach.

Firstly, it is essential to understand that chronic pain can often be multifactorial. In your case, the abdominal pain and lower back pain could be interrelated. The abdominal pain may not be solely due to gastrointestinal issues; it could also be influenced by musculoskeletal factors, nerve involvement, or even psychological components such as anxiety or stress, which can exacerbate physical symptoms.

Here are some steps you might consider taking:
1. Revisit Your Family Physician: Your family doctor can provide a comprehensive overview of your health and coordinate care among specialists. They can help determine if further investigations are necessary, such as imaging studies (like an MRI) to assess for any structural issues in the spine or abdomen that may not have been previously identified.

2. Consider a Pain Management Specialist: A pain management specialist can offer a multidisciplinary approach to your pain. They can provide treatments that may include medications, physical therapy, and possibly interventions like nerve blocks or injections that can help alleviate pain.

3. Physical Therapy: Engaging in physical therapy can be beneficial for both abdominal and lower back pain. A physical therapist can design a program tailored to your needs, focusing on strengthening the core muscles, improving flexibility, and addressing any postural issues that may contribute to your discomfort.

4. Psychological Support: Chronic pain can often lead to or exacerbate anxiety and depression. Consulting with a psychologist or psychiatrist who specializes in chronic pain can be beneficial. Cognitive-behavioral therapy (CBT) has been shown to help patients manage chronic pain by changing the way they perceive and respond to pain.

5. Dietary Considerations: Since you have been diagnosed with IBS, it might be worth revisiting your diet. Some patients find relief by following a low-FODMAP diet, which can help identify specific food triggers that exacerbate gastrointestinal symptoms. Consulting with a registered dietitian who specializes in gastrointestinal disorders can provide personalized guidance.

6. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, chiropractic care, or massage therapy. While these may not work for everyone, they can be worth exploring as part of a comprehensive pain management plan.

7. Further Investigations: If your symptoms persist, it may be necessary to explore other potential causes of your pain. Conditions such as endometriosis, fibromyalgia, or even certain autoimmune disorders can present with similar symptoms. A referral to a specialist in these areas may be warranted.

In summary, chronic abdominal and lower back pain can be complex and multifaceted. It is crucial to take a comprehensive approach that includes revisiting your family physician, considering pain management specialists, engaging in physical therapy, and exploring psychological support. Additionally, dietary adjustments and alternative therapies may provide relief. It’s essential to advocate for yourself and ensure that you receive the thorough evaluation and treatment you deserve.

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