Chronic Abdominal Pain

Defining Abdominal Pain

Chronic abdominal pain refers to persistent or recurrent discomfort or pain in the abdominal area lasting for at least three months.

Unlike acute abdominal pain, which typically indicates a sudden or short-term issue, chronic abdominal pain persists over an extended period. 

It can result from a wide range of conditions, including gastrointestinal disorders like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), gastritis, ulcers, or functional gastrointestinal disorders.

Other potential causes for long-term abdominal pain  include conditions affecting organs in the abdominal area such as the liver, gallbladder, pancreas, or reproductive organs. 

Chronic abdominal pain can significantly impact a person’s quality of life and often requires thorough medical evaluation and management to address its underlying cause and alleviate symptoms.

Where Does Abdominal Pain Occur?

Abdominal pain can occur anywhere between the chest and groin regions, encompassing the area referred to as the abdomen. 

This region includes various organs such as the stomach, intestines (small and large), liver, gallbladder, pancreas, kidneys, bladder, and reproductive organs. 

Therefore, the location of abdominal pain can vary depending on the underlying cause. It may be felt in the upper abdomen (above the belly button), lower abdomen (below the belly button), or across the entire abdominal area. 

The specific location of the pain, along with other symptoms and factors, can provide valuable clues to help diagnose the underlying condition causing the discomfort.

Chronic abdominal pain can occur in various regions of the abdomen, depending on the underlying cause.

Some common areas where chronic abdominal pain is experienced include:

• Upper Abdomen. Pain in the upper abdomen can be associated with conditions affecting organs such as the stomach, pancreas, liver, gallbladder, or the upper part of the small intestine (duodenum). Examples include gastritis, peptic ulcers, pancreatitis, gallstones, or liver disease.
• Lower Abdomen. Pain in the lower abdomen may be linked to issues with the lower digestive tract, including the intestines (small and large), appendix, bladder, or reproductive organs. Conditions like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), diverticulitis, urinary tract infections, or gynaecological issues can cause chronic abdominal pain in this area.
• Central Abdomen. Pain in the central abdomen can arise from various causes, including disorders affecting the small intestine, such as Crohn’s disease, or functional gastrointestinal disorders like functional dyspepsia.
• Periumbilical Area. Pain around the belly button (periumbilical area) can indicate conditions affecting multiple abdominal organs or referred pain from nearby structures.

The location of chronic abdominal pain, along with associated symptoms and diagnostic tests, helps your pain management physician determine the underlying cause and develop an appropriate and customised treatment plan.

What Causes Chronic Abdominal Pain?

Chronic abdominal pain can stem from a variety of underlying factors. Some common causes of persistent abdominal pain include (but are not limited to):

• Gastrointestinal Disorders. Conditions such as irritable bowel syndrome (IBS), gastro-oesophageal reflux disease (GORD), peptic ulcers, gastritis, inflammatory bowel disease (IBD) like Crohn’s disease or ulcerative colitis, and coeliac disease can all lead to chronic abdominal pain.
• Functional Gastrointestinal Disorders. These are conditions where the digestive system looks normal but doesn’t function correctly, resulting in symptoms like abdominal pain. Examples include functional dyspepsia and functional abdominal pain syndrome.
• Infections. Bacterial or viral infections affecting the stomach and intestines, such as gastroenteritis, can cause persistent abdominal pain.
• Food Intolerances. Intolerance to certain foods, such as lactose intolerance or fructose malabsorption, can lead to chronic abdominal pain, bloating, and discomfort.
• Gastrointestinal Motility Disorders. Conditions affecting the movement of food through the digestive tract, such as gastroparesis, can cause chronic stomach pain.
• Gallbladder Disease. Conditions like gallstones or inflammation of the gallbladder (cholecystitis) can lead to recurrent or chronic abdominal pain, often in the upper right abdomen.
• Pancreatitis. Inflammation of the pancreas can result in persistent abdominal pain, often radiating to the back.
• Functional Abdominal Pain Syndrome (FAPS). This is a condition characterised by chronic or recurrent abdominal pain that doesn’t have an identifiable cause.
• Psychological Factors. Stress, anxiety, and depression can exacerbate or even cause chronic abdominal pain in some individuals.
• Other Causes. Other potential causes of chronic abdominal pain include tumours, adhesions, pelvic inflammatory disease (PID), endometriosis, and certain medications.

It’s important to consult with a healthcare professional who specialises in pain management for an accurate diagnosis and appropriate ways to treat chronic abdominal pain.

Your treatment plan may involve lifestyle modifications, dietary changes, medications, and sometimes surgery, depending on the underlying cause.

What is an Abdominal Pain Specialist?

An abdominal pain specialist may include a gastroenterologist or a pain management specialist with expertise in abdominal pain.

They are medical professionals who specialise in diagnosing and treating conditions related to abdominal pain. 

These specialists have extensive training and experience in identifying the underlying causes of abdominal discomfort and developing tailored treatment plans to address them. 

They may utilise various diagnostic techniques such as imaging studies, endoscopy, or laboratory tests to identify the specific cause of abdominal pain.

Treatment options may include medication management, lifestyle modifications, dietary changes, therapeutic procedures, or surgery, depending on the underlying condition. 

Abdominal pain specialists work closely with patients to alleviate their symptoms, improve their quality of life, and manage any chronic conditions contributing to abdominal discomfort.

They often work as part of a multidisciplinary team of healthcare professionals like physical therapists, bowel hypnotherapists, psychologists, psychiatrists, dieticians, other medical specialists such as colorectal surgeons, hepatobiliary surgeons, general surgeons, urologist and gynaecologists to provide more holistic pain management and care. 

Multidisciplinary Teams for Chronic Abdominal Pain Management

A multidisciplinary team of chronic pain specialists typically consists of various healthcare professionals with expertise in different areas relevant to diagnosing and managing abdominal pain.

Some professionals you may work with as part of your abdominal pain management team include:

• Pain Management Specialists. Physicians with specialised training in managing pain, including abdominal pain, through medication, interventional procedures, and other therapeutic modalities.
• Gastroenterologists. Medical doctors specialising in the diagnosis and treatment of disorders of the digestive system, including those causing abdominal pain.
• Surgeons. Surgical specialists who may be involved in diagnosing and treating conditions that require surgical intervention, such as appendicitis, gallbladder disease, or bowel obstruction.
• Radiologists. Doctors who specialise in interpreting medical imaging studies, such as X-rays, CT scans, MRI scans, and ultrasound, to aid in the diagnosis of abdominal conditions.
• Gastrointestinal Nurses. Registered nurses with expertise in caring for patients with gastrointestinal disorders, providing education, support, and assistance with treatment plans.
• Dietitians and Nutritionists. Professionals who provide guidance on dietary modifications to manage conditions that cause abdominal pain, such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD).
• Psychologists/Psychiatrists. Mental health professionals who may be involved in managing the psychological aspects of chronic abdominal pain, such as anxiety, depression, or stress-related symptoms.
• Physical Therapists. Professionals who help manage abdominal pain through exercises, manual therapy, and other techniques aimed at improving mobility, strength, and function.
• Social Workers. Professionals who provide support services and resources to help patients cope with the social and emotional challenges associated with chronic abdominal pain, including navigating healthcare systems and accessing community resources.

By working collaboratively as a multidisciplinary team, Dr Mittal and her fellow pain management professionals can offer comprehensive care tailored to your unique needs, addressing the physical, psychological, and social aspects of abdominal pain management.

Why Do Pain Specialists Work with Gastroenterologists to Treat Chronic Abdominal Pain?

A gastroenterologist and a pain specialist are both healthcare professionals who play distinct roles in managing different aspects of health conditions, including those related to abdominal pain.

Here’s how they differ:

1. Specialty Focus:
   • Gastroenterologists. A gastroenterologist specialises in diagnosing and treating disorders of the digestive system. They have in-depth knowledge and expertise in conditions affecting organs such as the stomach, intestines, liver, gallbladder, and pancreas. Gastroenterologists commonly address conditions like acid reflux, ulcers, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and gastrointestinal cancers.
   • Pain Specialists. A pain specialist, also known as a pain management physician, focuses on diagnosing and treating various types of chronic pain conditions, including abdominal pain. They have specialised training in pain medicine and employ a range of techniques to alleviate pain, improve function, and enhance quality of life. Pain specialists may manage pain arising from different sources, including musculoskeletal pain, neuropathic pain, and visceral pain.
2. Approach to Care for Chronic Stomach Pain:
   • Gastroenterologists. Gastroenterologists typically focus on diagnosing the underlying cause of abdominal pain related to digestive system disorders. They may use diagnostic tests such as endoscopy, colonoscopy, imaging studies, and laboratory tests to evaluate the health of the gastrointestinal tract and identify specific conditions contributing to abdominal pain. Treatment approaches may include medications, lifestyle modifications, dietary changes, and procedures to manage or alleviate symptoms and address underlying conditions.
   • Pain Specialists. Pain specialists take a comprehensive approach to managing chronic pain, including abdominal pain. They assess the source of pain, its impact on daily functioning, and any associated physical or psychological factors. Treatment options may include medications, interventional procedures (such as nerve blocks or injections), physical therapy, psychological interventions, and complementary therapies. Pain specialists aim to reduce pain intensity, improve physical function, enhance coping skills, and optimise quality of life for patients with chronic pain conditions.
3. Collaboration and Multidisciplinary Care for Chronic Abdominal Pain:
   • Gastroenterologists. Gastroenterologists may collaborate with other specialists, such as surgeons, dietitians, radiologists, and oncologists, to provide comprehensive care for patients with digestive system disorders. They may also work closely with general practitioners to coordinate ongoing management and follow-up care.
   • Pain Specialists. Pain specialists often collaborate with a multidisciplinary team of healthcare professionals, including general practitioners, physical therapists, psychologists, and other specialists, to address the complex needs of patients with chronic pain conditions. They may integrate various treatment modalities to provide holistic care tailored to each patient’s individual needs and preferences.

In summary, while both gastroenterologists and pain specialists play important roles in managing abdominal pain, they approach care from different perspectives and employ distinct treatment modalities based on their respective areas of expertise. 

Pain management specialists like Dr Mittal and her team collaborate with gastroenterology professionals to enhance the quality of care and improve outcomes for patients with chronic abdominal pain.

How Does a Pain Specialist Treat Abdominal Pain?

The methods and techniques that Dr Mittal may employ to treat your abdominal pain varies depending on the underlying cause and individual patient needs. 

Some example treatment approaches may include:

• Medication Management. Prescription medications such as analgesics, antispasmodics, proton pump inhibitors, or antidepressants may be prescribed to alleviate pain and manage symptoms.
• Interventional Procedures. Pain specialists may perform minimally invasive procedures such as nerve blocks, trigger point injections, or epidural injections to target specific sources of abdominal pain and provide relief. In severe and refractory cases, this may include neuromodulation techniques such as spinal cord stimulation or peripheral field stimulation.
• Physical Therapy. Certain physical therapy techniques, including exercises, stretching, and manual therapy, may help improve abdominal muscle function, alleviate tension, and reduce pain.
• Cognitive-Behavioral Therapy (CBT). CBT techniques can be beneficial in managing chronic abdominal pain by addressing associated psychological factors such as stress, anxiety, or depression.
• Lifestyle Modifications. Pain specialists may recommend lifestyle changes such as dietary modifications, stress reduction techniques, exercise, and relaxation strategies to help manage abdominal pain and improve overall well-being.
• Referral to Other Specialists. In some cases, pain specialists may collaborate with other healthcare professionals such as gastroenterologists, surgeons, or psychologists to develop a comprehensive treatment plan tailored to the patient’s needs.

Overall, the goal of an abdominal pain specialist is to alleviate the chronic pain, improve quality of life, and empower patients to effectively manage their condition.

Treatment plans are customised based on the underlying cause of the pain, your medical history, and your unique preferences and goals.

What Does a Treatment Plan for Chronic Abdominal Pain Involve?

A treatment plan for chronic abdominal pain typically involves a multidisciplinary approach tailored to your individual needs.

Here’s what a plan to help mitigate chronic abdominal pain might entail:

• Comprehensive Evaluation and Diagnostic Assessment. The first step is a thorough evaluation by a healthcare provider, which may include a detailed medical history, physical examination, and possibly diagnostic tests such as blood tests, imaging studies (like an ultrasound or CT scan), or endoscopic procedures (such as an upper endoscopy or colonoscopy) to identify the underlying cause of the abdominal pain.
• Medical Management. Depending on the diagnosis, medications may be prescribed to alleviate symptoms and address the underlying condition. These may include:
  • Pain relievers (such as acetaminophen or nonsteroidal anti-inflammatory drugs) to manage discomfort.
  • Antacids or proton pump inhibitors to reduce stomach acid and relieve symptoms of acid reflux or gastritis.
  • Antispasmodic medications to alleviate abdominal cramping.
  • Antibiotics if the stomach pain is caused by an infection, such as H. pylori infection or bacterial overgrowth.
  • Medications to manage underlying conditions like inflammatory bowel disease, irritable bowel syndrome, or gastroparesis.
• Dietary Modifications. A registered dietitian or nutritionist may provide guidance on dietary changes that can help manage abdominal pain, such as:
  • Avoiding trigger foods that exacerbate symptoms, such as spicy foods, fatty foods, caffeine, or alcohol.
  • Following a low-FODMAP diet for conditions like irritable bowel syndrome (IBS).
  • Eating smaller, more frequent meals to reduce stomach discomfort.
  • Increasing fibre intake to improve digestion and relieve constipation.
• Lifestyle Changes. Lifestyle modifications can also play a significant role in managing chronic abdominal pain. These may include:
  • Stress reduction techniques such as mindfulness, meditation, yoga, or deep breathing exercises.
  • Regular exercise, which can help improve digestion, reduce stress, and promote overall well-being.
  • Adequate hydration, as dehydration can worsen digestive symptoms.
• Behavioural Therapy. For patients with psychological factors contributing to their pain (such as stress, anxiety, or depression), cognitive-behavioural therapy (CBT) or other forms of psychotherapy may be beneficial.
• Physical Therapy. In cases where musculoskeletal issues contribute to stomach pain, physical therapy techniques such as exercises, stretches, or manual therapy may help alleviate discomfort.
• Monitoring and Follow-up. Regular follow-up appointments with your pain management team are essential to monitor progress, adjust treatment as needed, and address any new symptoms or concerns that may arise.
• Patient Education and Support. Providing education about the underlying condition, treatment options, and self-management strategies is crucial for empowering patients to take an active role in their care and manage their pain effectively.

By combining these various approaches in a comprehensive treatment plan, Dr Mittal will work to alleviate your abdominal pain, improve your quality of life, and help you find long-term relief from your chronic pain symptoms.

The Challenges of Living with Chronic Abdominal Pain

Living with chronic abdominal pain presents numerous challenges that can significantly impact a person’s quality of life.

Some of these challenges include:

• Persistent Physical Discomfort. Chronic abdominal pain can cause persistent discomfort, ranging from mild to severe, which can interfere with daily activities such as eating, sleeping, and working.
• Emotional Distress. Dealing with ongoing pain can lead to stress, anxiety, depression, and other emotional issues, particularly if the pain affects one’s ability to engage in social activities or maintain relationships.
• Uncertainty and Frustration. It can be frustrating not knowing the exact cause of abdominal pain or finding effective treatments. The uncertainty surrounding the condition can lead to feelings of helplessness and hopelessness.
• Impact on Daily Activities. Chronic abdominal pain may limit a person’s ability to perform routine tasks and participate in activities they enjoy, leading to a decreased quality of life.
• Social Isolation. Pain and discomfort can make it challenging to engage in social activities, leading to feelings of isolation and loneliness.
• Financial Burden. Managing chronic abdominal pain may involve frequent doctor visits, diagnostic tests, medications, and sometimes surgeries or other procedures, resulting in financial strain.
• Difficulty in Correctly Diagnosing and Treating Stomach Pain. Identifying the underlying cause of chronic abdominal pain can be complex and may require multiple medical evaluations, tests, and consultations with different specialists. Additionally, finding an effective treatment plan may involve trial and error, which can be frustrating and time-consuming.
• Medication Side Effects. Some medications used to manage chronic abdominal pain may have adverse side effects, such as nausea, dizziness, constipation, or dependence, further complicating treatment.
• Impact on Mental Health. Living with chronic pain can take a toll on one’s mental health, leading to feelings of depression, anxiety, irritability, and decreased self-esteem.
• Effect on Relationships. Chronic abdominal pain can strain relationships with family, friends, and romantic partners, as it may be difficult for others to understand the extent of the pain and its impact on daily life.

Overall, managing chronic abdominal pain requires a comprehensive approach that addresses physical, emotional, and social aspects of the condition.

If you’re living with chronic abdominal pain, it is essential to seek support from healthcare professionals, family, and friends to cope with the challenges you face.

What Should You Do If You’re Experiencing Long Term Abdominal Pain?

If you’re experiencing long-term abdominal pain, it’s important to take the following steps as quickly as you can in order to start the process of treating and more importantly, alleviating your abdominal pain.

1. Seek Medical Attention. Schedule an appointment with your general practitioner or a gastroenterologist (abdominal pain specialist) for a thorough evaluation. They can help identify the underlying cause of your abdominal pain and develop an appropriate treatment plan.
2. Keep Track of Symptoms. Take note of any patterns or triggers related to your pain, such as specific foods, activities, or stressors. Keeping a symptom diary can provide valuable information to your healthcare provider.
3. Describe Your Pain. Be prepared to describe your abdominal pain in detail, including its location, severity, duration, and any associated symptoms such as nausea, vomiting, bloating, or changes in bowel habits. This information can assist your healthcare provider in making an accurate diagnosis.
4. Undergo Diagnostic Tests. Your healthcare provider may recommend various diagnostic tests to determine the cause of your abdominal pain, such as blood tests, imaging studies (e.g., ultrasound, CT scan), endoscopy, or colonoscopy.
5. Follow Treatment Recommendations. Once a diagnosis is made, follow your healthcare provider’s recommendations for treatment. This may include medications, dietary changes, lifestyle modifications, physical therapy, or other interventions aimed at relieving your abdominal pain and managing any underlying conditions.
6. Communicate with Your Healthcare Team. Keep open lines of communication with your healthcare provider and inform them of any changes in your symptoms or response to treatment. This allows for adjustments to your treatment plan as needed.
7. Seek Support. Dealing with long-term abdominal pain can be challenging, both physically and emotionally. Reach out to family members, friends, or support groups for emotional support and understanding.
8. Practice Self-Care. Engage in self-care practices to help manage stress and promote overall well-being. This may include relaxation techniques, regular exercise, adequate sleep, and healthy coping mechanisms.
9. Follow Up Regularly. Attend follow-up appointments with your healthcare provider as recommended to monitor your progress and make any necessary adjustments to your treatment plan.
10. Know When to Seek Emergency Care. If you experience severe or worsening abdominal pain, along with symptoms such as fever, vomiting blood, difficulty breathing, or severe abdominal tenderness, seek emergency medical attention immediately.

Remember that everyone’s experience with abdominal pain is unique, and what works for one person may not work for another.

It’s essential to work closely with medical professionals to find the most effective treatment approach for your specific situation.

If you’re having abdominal pain for days or months on end, it’s time to consult an abdominal pain specialist for relief. 

How do I Find an Abdominal Pain Specialist Near Me?

Finding a chronic abdominal pain specialist in your area starts with discussing your health concerns and issues with your general practitioner.

They can evaluate your symptoms, provide initial treatment or pain relief, and refer you to a specialist doctor for longer term care.

Your own network can also be helpful. Seek out recommendations from friends, family members, or colleagues who have experience with abdominal pain or other chronic pain issues.

They may be able to recommend an abdominal pain specialist in your area.

Hospitals or medical centres in your area may also offer chronic abdominal pain management.

They may have dedicated pain centres or clinics staffed by pain specialists who are well-equipped to treat chronic abdominal and related health issues.

These facilities often have multidisciplinary teams of experts and access to the latest treatment options. 

Be sure to take into account the clinic or specialist’s location, office hours, and availability when choosing a pain management doctor.

Also ensure the specialist has the adequate qualifications and local experience targeted to your type of pain. Dealing with chronic abdominal pain is challenging enough on its own! 

An abdominal pain specialist should assess your symptoms, medical history, and treatment preferences and create a personalised plan for your care.

Finding an abdominal pain specialist who listens to your concerns, communicates clearly, and offers confidence in their ability to provide you with proper treatment is the first step on a journey towards relief.

If you are in Melbourne or the surrounding region, contact the Persistent Pain Solutions clinic to meet with Dr Mittal who can diagnose your problem and more importantly, help alleviate your abdominal pain.

Persistent Pain Solutions for Abdominal Pain in Melbourne

Dr Meena Mittal and her collaborative team of pain management professionals are deeply committed to providing compassionate care and pain relief for every patient who arrives at the Persistent Pain Solutions clinic seeking relief from their chronic abdominal pain or any other type of chronic pain.

The emotional and physical toll on patients with chronic abdominal pain and their loved ones can be life-altering.

Dr Mittal aims to provide empathy, understanding, and support in every interaction, along with hands-on medical care to help alleviate your pain.

Persistent Pain Solutions is a compassionate environment where your pain and concerns are paramount. 

Dr Mittal and her collaborative team of professionals take the time to understand, engage, and evaluate your chronic abdominal pain and any other health concerns.

Together, we work with you to develop personalised treatment plans for your abdominal pain — and your overall physical and mental health!  

Compassionate care is our goal, and we are dedicated to providing relief from chronic abdominal pain and guiding our patients on a journey towards a better quality of life.