Chronic Abdominal Pain: Seeking Answers for Unexplained Symptoms

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The following conditions have already affected my life...
I have been seeing doctors for over a year with no results...
I experience long-term intermittent abdominal pain, which started after the onset of daily pain almost 24 hours a day in my lower back to the front and back of my ribcage.
There is a constant feeling of pain, pressure, tightness, and an indescribable sense of discomfort.
The abdominal pain does not occur every day for 24 hours, but the discomfort from my lower back to the ribcage is daily.
I often have unexplained bruises without any impact.
Additionally, my body has developed some black moles, which also began when the abdominal pain started.
The discomfort in the lower back to ribcage area is not fixed; it tends to be in the same place for several consecutive days before shifting to another location.
Sometimes it is in the front of the right lower back, sometimes in the front of the left lower back, and sometimes in both.
It can also occur in the back of the right lower back, the back of the left lower back, or both.
Occasionally, it is felt in the front of the left rib, the front of the right rib, the back of the left rib, or the back of the right rib.
In summary, the discomfort is in various locations and has been ongoing for over a year.
The abdominal pain has also persisted for more than a year, but it does not occur every day.
The discomfort in the lower back started with the abdominal pain, which was not present before.
I have consulted gastroenterology, gynecology, urology, and allergy/rheumatology, and all tests returned normal.
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 gastroenterologist stated that he cannot determine whether the discomfort in the lower back to ribcage area is related to gastrointestinal issues.
I have undergone endoscopy, barium enema, abdominal ultrasound, and stool tests, all of which were normal.
I am currently being evaluated by a neurologist, who finds my condition quite strange...
I would like to ask a professional doctor for advice: 1.
What should I do if all tests come back negative? The medication for irritable bowel syndrome has not improved my condition.
2.
What should I do about the discomfort in my lower back to ribcage area? 3.
Is there a connection between the bruising and black moles that started with the abdominal pain?

BV, 20~29 year old female. Ask Date: 2012/09/21

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, I have already replied to the previous question on 9/21 with best wishes to Dr.
Chen Chih-Feng from Taoyuan Hospital, Department of Health.

Reply Date: 2012/09/21

More Info

Chronic abdominal pain can be a perplexing and frustrating condition, especially when it persists for an extended period without a clear diagnosis. Your symptoms, which include persistent pain in the abdomen, discomfort in the lower back and rib area, and the presence of unexplained bruising and black spots, warrant a comprehensive evaluation. Here’s a breakdown of potential causes and recommendations based on your situation.

Possible Causes of Chronic Abdominal Pain
1. Functional Gastrointestinal Disorders: Conditions like Irritable Bowel Syndrome (IBS) can cause chronic abdominal pain and discomfort. IBS is characterized by a combination of abdominal pain and altered bowel habits, which may not always respond to standard treatments.

2. Musculoskeletal Issues: Given that you experience pain in the lower back and rib area, musculoskeletal problems such as muscle strain, ligament sprain, or even referred pain from spinal issues could be contributing factors. Conditions like fibromyalgia, which can cause widespread pain, should also be considered.

3. Neuropathic Pain: If your pain is described as a burning or tingling sensation, it may be neuropathic in nature. This type of pain can arise from nerve damage or irritation, which may not be easily identifiable through standard imaging or tests.

4. Vascular Issues: The presence of unexplained bruising and black spots could indicate a vascular issue, such as a bleeding disorder or issues with blood clotting. Conditions like thrombocytopenia (low platelet count) or other hematological disorders should be explored.

5. Autoimmune Conditions: Some autoimmune diseases can manifest with chronic pain and systemic symptoms. Conditions like lupus or vasculitis can cause abdominal pain and skin changes, including bruising.

6. Psychological Factors: Chronic pain can also be influenced by psychological factors such as anxiety and depression. These conditions can exacerbate the perception of pain and lead to a cycle of discomfort that is difficult to break.

Recommendations for Further Evaluation
1. Comprehensive Blood Work: Since you have noted the appearance of bruises and black spots, it is crucial to conduct a thorough hematological evaluation. This should include a complete blood count (CBC), liver function tests, and possibly tests for clotting factors.

2. Imaging Studies: If not already done, consider advanced imaging studies such as an MRI of the abdomen and pelvis to evaluate for any structural abnormalities that may not be visible on standard ultrasounds or X-rays.

3. Referral to Specialists: Given the complexity of your symptoms, it may be beneficial to consult with a pain specialist or a rheumatologist who can assess for systemic conditions that may be contributing to your symptoms.

4. Psychological Assessment: Since chronic pain can be influenced by psychological factors, a referral to a psychologist or psychiatrist specializing in chronic pain management may provide additional insights and coping strategies.

5. Multidisciplinary Approach: Engaging in a multidisciplinary approach that includes physical therapy, pain management, and possibly cognitive-behavioral therapy (CBT) could help address both the physical and psychological aspects of your pain.

Conclusion
Chronic abdominal pain, especially when accompanied by other systemic symptoms, can be challenging to diagnose and treat. It is essential to continue working closely with your healthcare providers, ensuring that all potential causes are explored. Keeping a detailed symptom diary, including the timing, duration, and nature of your pain, as well as any associated symptoms, can be helpful in guiding your medical team toward a more accurate diagnosis. Remember, persistence in seeking answers is key, and a multidisciplinary approach may provide the best chance for relief and improved quality of life.

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