Chronic Abdominal Pain Without Diagnosis: What Are Your Options? - Gastroenterology and Hepatology

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Chronic abdominal pain can be a perplexing and distressing condition, especially when extensive testing fails to yield a definitive diagnosis. Given your symptoms of persistent pain in the abdominal area, particularly on both sides and radiating to the lower back, along with the presence of tenderness and a sensation of inflammation, it is understandable that you are seeking further evaluation and management options.

Firstly, it is important to recognize that chronic abdominal pain can stem from a variety of causes, some of which may not be immediately apparent through standard diagnostic tests. Common conditions that can lead to chronic abdominal pain include gastrointestinal disorders such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and functional dyspepsia. However, since you have already undergone a colonoscopy and endoscopy, which returned normal results, it may be worthwhile to explore other potential causes.

One possibility is that your symptoms could be related to a condition known as myofascial pain syndrome, which involves pain arising from muscle and connective tissue. This could explain the tenderness and the "tingling" sensation you are experiencing. Additionally, conditions such as chronic pancreatitis or gallbladder disease may also present with similar symptoms, even if initial imaging studies appear normal.

Given that you have been treated for IBS but feel that your symptoms do not align with this diagnosis, it may be beneficial to consult with a gastroenterologist who specializes in functional gastrointestinal disorders. They may recommend further testing, such as a hydrogen breath test to evaluate for small intestinal bacterial overgrowth (SIBO) or a trial of dietary modifications to identify potential food intolerances.

Another avenue to consider is the possibility of abdominal wall pain, which can occur due to muscle strain or nerve entrapment. This type of pain can mimic visceral pain and may not be easily identified through traditional imaging studies. A physical examination by a healthcare provider skilled in musculoskeletal disorders may help in diagnosing this condition.

If you are concerned about the possibility of peritonitis or other serious abdominal conditions, it is essential to communicate this with your healthcare provider. While fever is a common symptom of peritonitis, it is not always present, and other signs such as localized tenderness, rigidity, or rebound tenderness may be indicative of an underlying issue that requires urgent attention.

In summary, while your extensive testing has not revealed a clear diagnosis, there are still several options to explore. Consider seeking a second opinion from a specialist in gastroenterology or pain management, who may offer new insights or recommend additional diagnostic tests. Keeping a detailed symptom diary, including the timing, duration, and nature of your pain, as well as any associated factors (such as dietary intake or stress levels), may also provide valuable information for your healthcare team.

Lastly, it is crucial to address your pain management needs. If your current treatment plan is not providing relief, discussing alternative medications or therapies, such as physical therapy, acupuncture, or cognitive-behavioral therapy, could be beneficial in managing your chronic pain and improving your quality of life. Remember, you are not alone in this journey, and advocating for your health is an important step toward finding relief.