Specialist Abdominal Pain Management
Specialist Abdominal Pain Management
Expert diagnosis and comprehensive treatment for abdominal pain from Dr. Mona Mubarak, Consultant in Chronic Pain Management. We provide targeted interventions for complex abdominal pain syndromes, including post-surgical pain, visceral pain, and functional abdominal disorders.
Understanding Abdominal Pain by Location
Abdominal pain is classified by quadrant location to help identify potential underlying causes. The abdomen is divided into four quadrants by imaginary vertical and horizontal lines through the umbilicus (navel).
Right Upper Quadrant (RUQ)
Common Causes:
- Gallbladder disease (cholecystitis, gallstones)
- Liver disorders (hepatitis, liver abscess)
- Duodenal ulcers
- Right kidney stones or infection
- Pneumonia (right lower lobe)
Pain Characteristics: Often sharp, may radiate to the right shoulder or back
Left Upper Quadrant (LUQ)
Common Causes:
- Spleen disorders (enlargement, rupture)
- Gastric ulcers or gastritis
- Pancreatitis (body/tail)
- Left kidney stones or infection
- Colon disorders (splenic flexure)
Pain Characteristics: Often dull, aching, may radiate to the back
Right Lower Quadrant (RLQ)
Common Causes:
- Appendicitis
- Crohn’s disease or ileitis
- Ovarian cysts or torsion (women)
- Ectopic pregnancy (women)
- Kidney stone (right ureter)
Pain Characteristics: Often sharp, localized, may start around the umbilicus
Left Lower Quadrant (LLQ)
Common Causes:
- Diverticulitis
- Ulcerative colitis
- Ovarian cysts or disorders (women)
- Colon cancer or polyps
- Kidney stone (left ureter)
Pain Characteristics: Often crampy, may be constant or intermittent
Special Considerations in Abdominal Pain
Some abdominal pain doesn’t fit neatly into quadrant classification:
- Diffuse pain: Throughout the abdomen (peritonitis, gastroenteritis, intestinal obstruction)
- Epigastric pain: Upper middle abdomen (pancreatitis, peptic ulcer, gastritis)
- Periumbilical pain: Around the navel (early appendicitis, small bowel disorders)
- Suprapubic pain: Lower middle abdomen (bladder infection, uterine conditions)
- Flank pain: Sides of the abdomen (kidney stones, pyelonephritis)
Common Causes of Chronic Abdominal Pain
Chronic abdominal pain (persisting >3 months) often requires specialized evaluation. As a pain consultant, Dr. Mubarak focuses on complex abdominal pain syndromes that may not have identifiable structural causes.
Types of Abdominal Pain by Mechanism
Visceral Pain
From internal organs, often poorly localized, crampy, or aching
Somatic Pain
From the abdominal wall, well-localized, sharp, constant
Neuropathic Pain
From nerve damage, burning, shooting, and hypersensitivity
Referred Pain
From elsewhere in the body (spine, chest), felt in the abdomen
Most Common Chronic Abdominal Pain Conditions
| Condition | Primary Mechanism | Typical Location | Key Characteristics |
|---|---|---|---|
| Irritable Bowel Syndrome (IBS) | Visceral hypersensitivity, gut-brain axis dysfunction | Diffuse or lower abdomen | Pain related to bowel movements, bloating, and altered bowel habits |
| Chronic Pancreatitis | Visceral inflammation, structural damage | Epigastric, radiates to the back | Constant or episodic severe pain, worse after eating, and weight loss |
| Abdominal Wall Pain Syndrome | Somatic (musculoskeletal), nerve entrapment | Localized abdominal wall | Sharp, well-localized, and reproduced by abdominal wall palpation |
| Post-Surgical Abdominal Pain | Neuropathic, adhesions, visceral hypersensitivity | At or near the surgical site | Persistent pain after surgery may have a burning/tingling component |
| Functional Dyspepsia | Visceral hypersensitivity, motility disorders | Upper abdomen (epigastric) | Early satiety, postprandial fullness, bloating, and upper abdominal pain |
| Chronic Mesenteric Ischemia | Visceral (vascular insufficiency) | Diffuse, often postprandial | Pain after eating (“intestinal angina”), fear of eating, weight loss |
Complex Abdominal Pain Syndromes
Dr. Mubarak specializes in complex abdominal pain conditions that often require multidisciplinary management:
- Chronic abdominal pain after surgery: Including post-hernia repair, post-cholecystectomy, and post-hysterectomy pain syndromes
- Visceral hyperalgesia: Heightened pain perception from internal organs
- Central sensitization syndromes: Where the nervous system amplifies pain signals
- Opioid-induced hyperalgesia: Paradoxical increase in pain with opioid use
- Abdominal migraine: Recurrent episodes of abdominal pain without headache
Comprehensive Abdominal Pain Diagnosis
Accurate diagnosis of abdominal pain requires a systematic approach, especially when pain becomes chronic. Our evaluation integrates medical history, physical examination, diagnostic testing, and pain mechanism assessment.
Diagnostic Process for Chronic Abdominal Pain
Detailed Medical History
- Pain characteristics: location, quality, intensity, timing
- Relationship to food, bowel movements, and menstrual cycle
- Previous surgeries, infections, or abdominal trauma
- Medication history, including opioids
- Psychosocial factors, stress, anxiety, depression
Comprehensive Physical Examination
- Abdominal examination: palpation, percussion, auscultation
- Carnett’s test to differentiate visceral vs. somatic pain
- Assessment for hernia, masses, and organomegaly
- Neurological examination of the abdominal wall
- Examination of the spine, hips, and pelvic structures
Diagnostic Testing & Imaging
- Laboratory tests: CBC, liver function, amylase/lipase, and inflammatory markers
- Imaging: Ultrasound, CT scan, MRI, endoscopic procedures
- Specialized tests: Gastric emptying, colonic transit, anorectal manometry
- Diagnostic nerve blocks: Ilioinguinal, iliohypogastric, genitofemoral blocks
- Psychological assessment when indicated
Pain Mechanism Identification
- Differentiating visceral, somatic, and neuropathic components
- Assessing for central sensitization
- Evaluating psychosocial contributors
- Identifying opioid-related complications
- Formulating an integrated diagnosis and treatment plan
Specialized Diagnostic Approaches
For complex abdominal pain, we employ specialized diagnostic techniques:
- Diagnostic nerve blocks: Local anesthetic injections to identify specific pain generators
- Ultrasound-guided examination: Dynamic assessment of abdominal wall and organs
- Quantitative sensory testing: Assessment of pain processing and central sensitization
- Multidisciplinary team assessment: Collaboration with gastroenterologists, surgeons, psychologists
- Pain diaries: Detailed tracking of pain patterns, triggers, and responses
Comprehensive Abdominal Pain Treatments
Effective management of chronic abdominal pain requires a multimodal approach tailored to the specific pain mechanisms, underlying conditions, and individual patient factors.
Pharmacological Management
| Medication Class | Mechanism of Action | Indications | Special Considerations |
|---|---|---|---|
| Neuropathic Agents (Gabapentin, Pregabalin) |
Modulate nerve signaling, reduce central sensitization | Neuropathic abdominal pain, visceral hypersensitivity | Require slow titration, monitor for sedation, dizziness |
| Low-Dose Antidepressants (TCAs, SNRIs) |
Modulate pain pathways, improve sleep, treat comorbid depression/anxiety | Central sensitization, functional abdominal pain, and comorbid mood disorders | Amitriptyline/nortriptyline for sleep, duloxetine for pain, and mood |
| Visceral Analgesics (Peppermint oil, Antispasmodics) |
Reduce smooth muscle spasm, visceral sensitivity | IBS, functional dyspepsia, visceral hyperalgesia | Peppermint oil for IBS, hyoscine/dicyclomine for spasm |
| Topical Agents (Lidocaine, Capsaicin) |
Local pain relief with minimal systemic effects | Abdominal wall pain, nerve entrapment syndromes | Lidocaine patches/cream, capsaicin for the neuropathic component |
| Opioids (Limited Role) | Central pain modulation (μ-opioid receptors) | Severe pain refractory to other treatments, short-term use only | Risk of hyperalgesia, dependence, constipation; specialist supervision required |
Interventional Pain Procedures
For patients with persistent abdominal pain despite conservative treatment, we offer targeted interventions:
Nerve Blocks & Ablation
Targeted interruption of pain signaling from specific nerves.
- Ilioinguinal/iliohypogastric blocks: For post-hernia repair pain, lower abdominal pain
- Genitofemoral nerve blocks: For groin and lower abdominal pain
- Celiac plexus block: For pancreatic cancer pain, chronic pancreatitis
- Superior hypogastric plexus block: For pelvic pain, endometriosis-related pain
- Radiofrequency ablation: Longer-lasting nerve modulation (6-24 months)
Neuromodulation
Advanced techniques modulating nervous system activity.
- Spinal cord stimulation: For refractory neuropathic abdominal pain
- Peripheral nerve stimulation: For localized abdominal wall pain
- Transcutaneous electrical nerve stimulation (TENS): Non-invasive option for some patients
- Dorsal root ganglion stimulation: Targeted approach for specific dermatomes
- Benefits: Often reversible, adjustable, minimally invasive
Other Interventions
Additional procedures for specific abdominal pain conditions.
- Trigger point injections: For abdominal wall myofascial pain
- Botulinum toxin injections: For abdominal wall muscle spasm
- Epidural steroid injections: For radicular pain referring to the abdomen
- Intrathecal drug delivery: For severe, refractory abdominal pain
- Adhesiolysis: For pain from post-surgical adhesions (in collaboration with surgeons)
Multidisciplinary & Integrative Approaches
Comprehensive abdominal pain management extends beyond procedures and medications:
Holistic Pain Management Strategies
- Cognitive Behavioral Therapy (CBT): For pain coping, stress management, and maladaptive thoughts
- Gut-directed hypnotherapy: Particularly effective for IBS and functional abdominal pain
- Dietary modifications: Low FODMAP diet, elimination diets, nutritional counseling
- Physical therapy: For abdominal wall dysfunction, posture correction, and core stabilization
- Mindfulness & relaxation techniques: Stress reduction, pain perception modulation
- Graded activity/exercise: Gradual increase in activity to improve function
Treatment Algorithm for Chronic Abdominal Pain
- Step 1 (Comprehensive Assessment): Accurate diagnosis, pain mechanism identification, and patient education
- Step 2 (First-line Treatments): Pharmacological management, dietary modifications, physical therapy, psychological approaches
- Step 3 (Interventional Procedures): Diagnostic and therapeutic nerve blocks, trigger point injections
- Step 4 (Advanced Interventions): Neuromodulation, radiofrequency ablation, intrathecal therapy
- Step 5 (Maintenance & Rehabilitation): Long-term management, flare prevention, functional restoration
Specialist Abdominal Pain Consultation
Chronic abdominal pain can significantly impact quality of life, nutrition, and psychological well-being. Early specialist intervention often leads to better outcomes, especially when standard approaches have failed.
When to Seek Specialist Abdominal Pain Evaluation
- Abdominal pain persisting >3 months despite standard treatments
- Pain that limits daily activities, work, or social functioning
- Multiple negative investigations, but ongoing significant pain
- Post-surgical abdominal pain persisting beyond expected recovery
- Suspected neuropathic or complex regional pain syndrome
- Need for opioid management or complex medication regimens
- Abdominal pain with significant psychological distress or functional impairment
We offer comprehensive abdominal pain assessments, including diagnostic nerve blocks, multidisciplinary collaboration, and personalized treatment plans.
