Abdominal Pain
Chronic abdominal pain poses a significant challenge to most clinicians. While a careful review of a patient's medical history, a thorough physical examination, and appropriate studies usually help provide an accurate diagnosis and treatment plan for acute (short-term or sudden onset) pain, the same cannot be said for chronic (prolonged or long-term) pain. In fact, some therapies appropriate for acute pain, such as analgesics (pain medications), rest, and surgery, may only worsen chronic pain.
The first step in managing chronic abdominal pain is determining the nature, causes, and development of any abnormal condition, and the mechanism of pain. For optimal management, pain must be assessed from biological, social, cognitive, emotional, and behavioral perspectives.
Many factors, listed below, may increase suffering and disability in chronic pain. It is important to recognize these factors because most can be treated.
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Anxiety and depression
Anxious feelings are common and often occur in every one of us, but they may cause emotional and physical distress. Physical symptoms of anxiety include increased muscle tension, which can worsen symptoms of irritable bowel disease (a group of inflammatory diseases of the gastrointestinal tract that includes Crohn's disease and ulcerative colitis). Combinations of behavioral therapy, other treatment methods, and/or medication have proven highly effective in reducing the symptoms of anxiety.
The percentage of patients who have chronic pain and experience depression range from 30 to 80 percent. Recognizing depression is important because pain can be a symptom of depression, and depression makes pain worse. Patients with intractable pain and symptoms of depression may be treated with antidepressant medications.
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Activity level
Pain is minimized by distraction and increased by attention. When we spend time involved in activities, attention is drawn away from pain symptoms. But a lack of activity increases self-awareness and tends to focus attention on pain. Also, inactivity not only leads to general de-conditioning, but also to weakening of the abdominal muscles, which contributes to poor posture and increases pressure on the joints.
Inactivity also decreases flexibility. When the inactive muscles are used, they easily become strained, causing pain.
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Cognitive and emotional factors
How a person understands and interprets pain can influence suffering. For example, cancer patients suffer more when they believe their pain indicates tumor progression than when they attribute it to lesser causes. Thus, a person's interpretation (the meaning) of pain can be a major factor in pain tolerance.
Irritability and anger also are common among people who suffer from chronic pain. The anger often is directed at work, the family, or professionals who cannot provide a cure for the cause of the pain.
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Addictive behavior
Chemical dependence, including narcotics, tranquilizer addictions, and alcoholism, are important contributors to chronic pain. Not only does chemical dependence increase pain symptoms, but it also can produce cravings, muscle spasms, and other symptoms that are experienced as pain. Drug use impairs a person's inability to cope with life's demands, making the sick role more acceptable.
Treatment
Common reinforcers for chronic pain include avoidance of responsibilities at home or work, financial compensation related to disability, and increased attention from family and friends. In treating patients, it is necessary to explore several issues, such as the use of pain medication, work performance, absenteeism, and financial compensation to identify factors that may encourage a patient to accept the role of being sick. Educating patients and families must be a major focus of treatment to correct misinformation about chronic pain, to minimize enabling behaviors, and to ultimately reward the patient for making an effort to reduce pain and become well.
Antidepressant medications also may play a role in treatment, especially for patients who have mood disorders. Biofeedback and stress management techniques also are beneficial for patients experiencing anxiety. Biofeedback is a technique that helps a person become more aware of and learn to deal with the body's response to pain. This alternative therapy emphasizes relaxation and stress-reduction techniques.
When standard treatments are not successful, patients with chronic pain should undergo an evaluation and treatment from a multidisciplinary team of specialists. The goals of treatment should include a reduction in pain and suffering and a return to normal life.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/26/2004
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