Seeking Answers: Unexplained Abdominal Pain in a 35-Year-Old Man

Doctor, could you please assist me?

My son is ill, and despite searching through various major hospitals, we have been unable to find the cause of his condition.
Our family is now at a loss.
Here are the details of his illness: he is a 35-year-old male, experiencing pain located above the navel and between the two sternum bones.
This has been ongoing since September of last year.
The pain starts around 3 to 4 AM and lasts throughout the day, only easing slightly by about 6 to 7 PM, approximately by 10%.
Initially, the pain felt like bloating, but it has intensified recently, while the bloated sensation has somewhat diminished.
The pain feels as if something is clenching, and at times he feels the urge to drink water, but drinking does not alleviate the pain.
Pressure, touch, or movement exacerbates the pain.
The pain is consistent whether before meals, after meals, or on an empty stomach, and he has no appetite, forcing himself to eat only half a bowl of porridge and half a bowl of vegetables per meal.

Other symptoms include a previous sensitivity to heat, which has improved somewhat; however, his auditory, olfactory, and gustatory senses have become very sensitive.
Even a slight noise can cause discomfort, and he can only tolerate very bland food, avoiding any greasy items.
His body temperature was previously below 36 degrees Celsius, but now it ranges from 36.5 to 36.8 degrees Celsius.

He has undergone several examinations, including gastroscopy, colonoscopy, small bowel imaging, CT scans, abdominal ultrasound, PET scans, salivary nuclear imaging, and stool occult blood tests.
Both urination and defecation are normal, and none of the tests have revealed any abnormalities.
Subsequently, the doctors categorized his pain as being caused by psychological stress or neurological issues; however, he does not experience any stress.

We are seeking your assistance to understand if there are any other diseases that could cause such pain or if there are any tests that may have been overlooked.
Could this condition be classified as a rare or special disease? Please let us know.
We would be immensely grateful for any help you can provide.

Mr. Lin, 30~39 year old female. Ask Date: 2002/07/08

Dr. Xu Ruihong reply Gastroenterology and Hepatology

Based on the detailed symptoms you described and the fact that the patient has undergone numerous tests with normal results, it appears that there are no structural abnormalities.
However, issues related to gastrointestinal motility are among the most challenging to assess.
It may be advisable to first attempt pharmacological treatment or consult a large medical center to inquire about relevant tests.
Regarding pain that may be caused by psychological stress or neurological factors, it is best to consult a psychiatrist, as the presence of stress may not be something that others (including family members) can fully assess.

Reply Date: 2002/07/08

More Info

It sounds like your son has been experiencing a very challenging and distressing situation with his abdominal pain for the past ten months. Given the detailed description of his symptoms and the extensive tests he has already undergone, it is understandable that you and your family feel frustrated and helpless in finding a diagnosis.

From the information provided, your son is experiencing persistent pain located above the navel, which intensifies in the early morning hours and gradually subsides in the evening. The pain is described as a gnawing sensation, and he has reported a loss of appetite, sensitivity to sounds, and changes in his temperature regulation. Despite undergoing numerous diagnostic tests, including endoscopies, imaging studies, and blood tests, no abnormalities have been identified, leading to a classification of his condition as potentially psychosomatic or related to nerve issues.

While it is important to consider psychological factors in chronic pain cases, especially when no physical cause can be found, it is also crucial to explore other potential medical conditions that may have been overlooked. Here are some possibilities and recommendations for further evaluation:
1. Functional Gastrointestinal Disorders: Conditions such as Irritable Bowel Syndrome (IBS) or Functional Dyspepsia can cause chronic abdominal pain without any identifiable structural abnormalities. These disorders often require a different approach to management, focusing on dietary changes, stress management, and sometimes medications that target gut motility or pain.

2. Visceral Hyperalgesia: This condition involves an increased sensitivity to pain in the internal organs. It can occur after an episode of acute abdominal pain or surgery and may not show up on standard tests. A referral to a pain specialist or a gastroenterologist with experience in functional disorders may be beneficial.

3. Neuropathic Pain: If there is any nerve involvement, such as nerve entrapment or neuropathy, this could lead to chronic pain. A neurologist could evaluate for conditions like abdominal migraine or other neuropathic pain syndromes.

4. Endocrine Disorders: Conditions such as adrenal insufficiency or thyroid disorders can sometimes present with nonspecific abdominal pain and altered appetite. A thorough evaluation of endocrine function may be warranted.

5. Rare Conditions: Although less common, conditions such as mesenteric ischemia (insufficient blood flow to the intestines), or even certain autoimmune disorders, could lead to chronic abdominal pain. If there is a suspicion of these, further specialized imaging or tests may be necessary.

6. Psychological Evaluation: Even in the absence of apparent stressors, psychological factors can contribute to chronic pain. A consultation with a psychologist or psychiatrist specializing in chronic pain may provide insights into coping strategies and treatment options.

7. Second Opinion: Given the complexity of your son's case, seeking a second opinion from a specialized medical center or a multidisciplinary pain clinic may provide new perspectives and treatment options.

In conclusion, while the journey to find the cause of your son's pain has been long and frustrating, it is essential to continue advocating for him. Exploring functional disorders, considering the role of nerves and psychological factors, and possibly seeking a second opinion could lead to a more comprehensive understanding of his condition. It is crucial to approach this with an open mind and a willingness to explore various avenues of treatment. Your son's quality of life is paramount, and with persistence, a solution may be found.

Similar Q&A

Understanding Unexplained Abdominal Pain: Causes and Next Steps

Hello Doctor, my boyfriend (28 years old) has been experiencing intermittent radiating abdominal pain (similar to an electric shock) since March of last year. The pain does not occur when pressure is applied, and it has persisted for over a year. Initially, he did not experience ...

Dr. Wu Fangcan reply Family Medicine
Based on your statement, it is recommended to consult a neurologist or neurosurgeon for an examination. Thank you.

Unexplained Abdominal Pain: Understanding Symptoms and Causes

Hello Dr. Chen, I have been experiencing continuous abdominal pain for the past two weeks. The pain is not localized and I haven't had diarrhea or anything like that. I have already undergone X-rays and an ultrasound, both of which showed no issues or stones. Over the last t...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
It is recommended to undergo a sigmoidoscopy (anorectal surgery) and a barium enema (which can be scheduled through either anorectal surgery or gastroenterology) for examination. If no significant findings are observed, it may be related to functional disorders. Wishing you good ...

Understanding Unexplained Back and Stomach Pain: A Guide for Seniors

Hello Doctor: I apologize for bothering you, but I would like to ask for your help in answering the following questions. I know an elder (around 60 years old) who experiences back pain every day around dusk, which lasts until the next day before improving. Additionally, they ofte...

Dr. Cai Jueren reply Family Medicine
Hello: Generally speaking, the simultaneous occurrence of back pain and stomach pain is often indicative of an acute condition. For example, acute gastrointestinal ulcers, acute pancreatitis, gastric perforation, and myocardial infarction can all cause referred back pain. The sym...

Understanding Abdominal Pain and Mass in an 86-Year-Old Patient

An 86-year-old individual, with a height of 146 cm and weight of 40 kg, is independent in daily activities. Last night, while getting up to use the bathroom, they suddenly experienced severe pain in the left upper abdomen, described as feeling like a blunt force trauma. However, ...

Dr. Chen Shidian reply Gastroenterology and Hepatology
It is recommended to visit the emergency department (not necessarily a large hospital, but any clinic with gastroenterology or family medicine services that offers ultrasound and is open on weekends) for an evaluation to understand the severity of the condition.