Department of Chronic Abdominal Pain Management

What Is Chronic Abdominal Pain?

Chronic Abdominal Pain (CAP) refers to pain within the abdominal area that persists for at least 3–6 months. The pain may be continuous or intermittent. This condition can arise from many sources, including the gastrointestinal system, urinary system, nervous system, or even the abdominal wall muscles themselves. Because causes are diverse, accurate diagnosis is essential for effective treatment.

 

Causes of Chronic Abdominal Pain

1. Gastrointestinal Disorders

• Peptic Ulcer Disease: Ulcers caused by gastric acid, presenting as burning epigastric pain, often worse on an empty stomach.

• Gastroesophageal Reflux Disease (GERD): Heartburn, upper abdominal discomfort, and acid regurgitation.

• Irritable Bowel Syndrome (IBS): Crampy abdominal pain associated with bowel habit changes.

• Inflammatory Bowel Disease (IBD): Including Crohn’s disease and ulcerative colitis, causing chronic abdominal pain, persistent diarrhea, and weight loss.

• Gallstones: Right upper abdominal pain, especially after fatty meals.

 

2. Abdominal Muscle and Nerve-Related Pain

• Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): Entrapment of nerves in the abdominal wall causing localized, sharp or burning pain.

• Myofascial Pain Syndrome: Trigger points in abdominal muscles with referred pain patterns.

• Neuropathic Pain: Due to nerve injury or dysfunction, such as after abdominal surgery or from diabetic neuropathy.

 

3. Urinary Tract Disorders

• Kidney Stones: Severe colicky pain in the flank or lateral abdomen, possibly radiating to the groin.

• Urinary Tract Infection (UTI): Suprapubic or lower abdominal pain with dysuria.

• Interstitial Cystitis: Chronic bladder-related pelvic or lower abdominal pain, often worse during urination.

• Pyelonephritis: Upper urinary tract infection with flank pain, fever, and chills.

 

4. Other Systemic Causes

• Endometriosis: In women, causing chronic pelvic/lower abdominal pain and severe menstrual pain.

• Hernia: Pain due to protrusion and compression of abdominal contents.

• Intra-abdominal Cancers: Such as pancreatic, gastric, or ovarian cancer.

 

Diagnostic Evaluation

Diagnosis requires a thorough history, physical examination, and appropriate investigations, including:

• Blood tests: To assess inflammation, infection, or anemia.

• Abdominal ultrasound: For gallstones, kidney stones, and organ evaluation.

• CT scan / MRI: For detailed assessment of intra-abdominal pathology.

• Endoscopy / Colonoscopy: To evaluate peptic ulcers, IBD, or other mucosal disease.

• Urinalysis: To detect infection or stones.

• Nerve block diagnostic test: Local anesthetic injection to confirm nerve-related pain sources.

 

Treatment Approaches

1. Pharmacological Treatment

• Acid suppression: PPIs or H2 blockers for ulcers and GERD.

• Analgesics / NSAIDs: For inflammatory pain (used judiciously).

• Antispasmodics: For IBS-related cramping.

• Neuropathic pain agents: Gabapentin, Pregabalin, Mirogabalin.

• Antidepressants: TCAs or Duloxetine for chronic neuropathic pain modulation.

• Antibiotics: For urinary tract infections or other bacterial causes.

 

2. Physical Therapy and Behavioral Modification

• Core and abdominal muscle strengthening exercises.

• Myofascial release techniques for trigger-point pain.

• Breathing exercises, yoga, and stress reduction to address pain amplification.

 

3. Interventional Pain Management

• Trigger Point Injections: Local anesthetic or steroid into painful muscle knots.

• Nerve Block Injections: For ACNES or neuropathic abdominal pain.

• Radiofrequency Ablation (RFA): Uses radiofrequency energy to interrupt pain-transmitting nerves for longer-lasting relief.

• Botulinum Toxin Injections: For chronic muscle spasm-related pain.

 

Treat the Cause, Not Just the Symptom

The most effective management of chronic abdominal pain focuses on identifying and treating the underlying cause, rather than providing temporary symptom relief alone. If pain does not respond to initial therapy, consultation with a specialist is essential for targeted diagnosis and care.

 

Our Services

We provide comprehensive care for chronic abdominal pain, including:

• Targeted nerve injections for pain relief

• Spinal Cord Stimulator (SCS) therapy

• Implantation of spinal electrical stimulation devices

• Radiofrequency heat therapy targeting pain-transmitting nerves

Our goal is precise diagnosis, personalized treatment, and lasting relief—so patients can return to daily life with comfort and confidence.

We offer comprehensive care for chronic abdominal pain, including targeted nerve injections, spinal cord stimulator therapy, implantation of spinal devices, and radiofrequency heat therapy to precisely diagnose and treat pain for lasting relief and improved daily life.