Chronic Abdominal Pain: Which Specialist Should You Consult?

I'm sorry, but I cannot assist with that?

The following situation has already affected my life...
I have been seeing doctors for over a year without any results...
I experience intermittent abdominal pain, which, when it starts, leads to almost 24-hour pain in both sides of my lower back and the front and back of my ribcage.
There is a constant feeling of pressure, tightness, and an indescribable sense of discomfort.
The abdominal pain does not occur every day for 24 hours, but the discomfort in my lower back to ribcage area is daily and varies in location.
It often lasts for several consecutive days in one area before shifting to another.
Sometimes it is in the front of my right lower back, sometimes in the front of my left lower back, and at times in both sides.
It can also occur in the back of my right lower back, the back of my left lower back, or both.
Additionally, I experience discomfort in the front and back of my left and right ribcage at different times.
In summary, the discomfort is inconsistent in location.
This situation has persisted for over a year, and while the abdominal pain has also lasted for more than a year, it does not occur daily.
The discomfort in my lower back to ribcage area began with the onset of the abdominal pain, which was not present before.
I have consulted gastroenterology, gynecology, urology, and allergy/rheumatology specialists, 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 the abdominal pain or lower back discomfort.
The pediatric gastroenterologist mentioned that he cannot determine whether the discomfort in my lower back to ribcage area is related to gastroenterology.
I have undergone endoscopy, barium X-rays, abdominal ultrasound, and stool tests, all of which returned normal results.
I would like to ask a professional doctor for advice on which specialty I should consult regarding my discomfort from my lower back to ribcage.

WQ, 20~29 year old female. Ask Date: 2012/09/06

Dr. Niu Zhenyuan reply Surgery

As mentioned by the author, the pain is widespread with no fixed tender points, resembling symptoms of myofascial pain syndrome.
It is generally triggered by work or daily activities, such as doing housework or taking care of children.
In terms of treatment, the most important aspect is rest, along with the use of oral analgesics for symptom control, followed by seeking rehabilitation therapies such as heat therapy and electrical stimulation.
A hospital examination can help rule out spinal issues or referred pain caused by abdominal organ conditions.

Reply Date: 2012/09/06

More Info

Chronic abdominal pain, especially when accompanied by persistent discomfort in the lower back and rib area, can be quite challenging to diagnose and manage. Given your extensive history of consultations with various specialists—including gastroenterology, gynecology, urology, and rheumatology—it's understandable that you're feeling frustrated and seeking further guidance.

Understanding Your Symptoms
Your description of the pain being intermittent and shifting locations is significant. Chronic pain that is not localized can sometimes be attributed to a variety of factors, including musculoskeletal issues, nerve-related pain, or even referred pain from internal organs. The fact that your abdominal pain is not constant but your discomfort in the lower back and rib area is persistent suggests that there may be multiple underlying issues at play.

Potential Causes
1. Musculoskeletal Issues: Given the nature of your pain, it’s possible that you may be experiencing musculoskeletal pain. Conditions such as muscle strain, ligament sprain, or even spinal issues like herniated discs can cause pain that radiates to the abdomen and back.
2. Nerve Pain: Conditions like fibromyalgia or neuropathic pain can lead to widespread discomfort that may not be easily attributed to a single cause.
3. Visceral Pain: Sometimes, pain from internal organs can manifest in areas that seem unrelated. For example, issues with the kidneys, pancreas, or even the gastrointestinal tract can cause referred pain in the back and rib areas.

4. Psychological Factors: Chronic pain can also be influenced by psychological factors such as anxiety or depression, which can amplify the perception of pain and discomfort.

Recommended Specialists
Given the complexity of your symptoms and the fact that previous consultations have not yielded a diagnosis, I recommend the following steps:
1. Pain Management Specialist: A pain management specialist can provide a comprehensive evaluation of your pain. They may suggest diagnostic imaging like an MRI or CT scan to look for any underlying structural issues that may have been missed. They can also offer treatments such as nerve blocks or physical therapy.

2. Rheumatologist: Since you have already consulted with a rheumatologist, it may be worth revisiting them, especially if there are any signs of autoimmune conditions that could be contributing to your symptoms.

3. Gastroenterologist: Although you have seen a gastroenterologist, consider seeking a second opinion from a different specialist in this field, particularly one who specializes in functional gastrointestinal disorders. They may have different insights or treatment options.

4. Neurologist: If nerve-related pain is suspected, a neurologist can evaluate for conditions like neuropathy or other nerve-related issues that could be contributing to your symptoms.

5. Psychiatrist/Psychologist: If psychological factors are suspected, consulting with a mental health professional can be beneficial. They can help address any anxiety or depression that may be exacerbating your pain.

Next Steps
1. Document Your Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare providers.

2. Seek a Multidisciplinary Approach: Sometimes, a team approach involving multiple specialists can provide a more comprehensive understanding of your condition.

3. Consider Alternative Therapies: In addition to traditional medical approaches, therapies such as acupuncture, chiropractic care, or physical therapy may provide relief.

4. Stay Persistent: Continue advocating for your health. If you feel that your concerns are not being addressed, don’t hesitate to seek out new specialists or medical centers that may offer a fresh perspective.

In conclusion, chronic abdominal pain and associated discomfort can stem from a variety of sources, and it often requires a thorough and multidisciplinary approach to identify the underlying causes. By consulting with the right specialists and maintaining a proactive stance in your healthcare journey, you can work towards finding relief and improving your quality of life.

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