Establishing Diagnosis of Chronic Abdominal Pain: Pain Medicine view
Component Visceral Somatic Nerve fiber Ad, C Ab [allodynia], Ad, C End organ silent nociceptors Yes (~80 %) Yes (~20 %) DH laminar synapse I, V, X I-to-V and X…
PAIN MEDICINE
Establishing Diagnosis of Chronic Abdominal Pain: Gastroenterologist View
Etiology Typical diagnostic tests Treatment Organic Gallstones US, HIDA scan Cholecystectomy Cholangitis RUQ US, ERCP ERCP Appendicitis CT scan Appendectomy Peptic ulcer disease Upper endoscopy, H. pylori testing Proton pump…
Chronic Pancreatitis With or Without Acute Exacerbations: Novel Options for Pain Control
Alcoholic pancreatitis Hereditary pancreatitis Autoimmune pancreatitis Metabolic pancreatitis (hypercalcemia, hyperlipidemia) Tropical pancreatitis Idiopathic Increased daily alcohol intake has been linked to a higher risk for chronic pancreatitis. There is, however,…
Psychological Determinants and Treatments for Chronic Abdominal Pain
Fig. 25.1 The functional anatomy of the hypothalamic–pituitary–adrenal axis. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 2013. All Rights Reserved Stress has been well documented…
Neurosurgical Options for Control of Chronic and Malignant Abdominal Pain
Fig. 24.1 Ascending sensory spinal cord pathways. (a) Spinothalamic tract. (b) Dorsal midline visceral nociceptive pathway. The black box indicates the location for cordotomy procedure and the yellow box indicates…
Abdominal Pain in Irritable Bowel Syndrome (IBS)
Recurrent abdominal pain or discomfortb at least 3 days/month in the last 3 months associated with two or more of the following: 1. Improvement with defecation 2. Onset associated with a change…
Intrathecal Therapy for Nonmalignant and Malignant Abdominal Pain
Drug Range of doses Morphine 1.0–20 mg/day Hydromorphone 0.5–25 mg/day Sufentanil 10–100 μg/day Bupivacaine 6–20 mg/day Clonidine 250–2,000 μg/day Thus, compounding by a trained pharmacist will be needed. The goal…
Gastric and Other Visceral Stimulation for Chronic Painful Gastrointestinal Motility Disorders
61. Yin J, Chen JD. Mechanisms and potential applications of intestinal electrical stimulation. Dig Dis Sci. 2010;55(5):1208–20.PubMed 62. Chen JD, Lin HC. Electrical pacing accelerates intestinal transit slowed by fat-induced…
Opioids in Abdominal Pain
Medication Routes SAO vs. LAO Onset of action Duration of action PCA-availability Fentanyl TD, TM, IV, SC, Both 12–24 h TD, 72 h TD, Yes, (Duragesic, Actiq, Fentora) 5–15 min…
Cancer-Related Abdominal Pain
Fig. 13.1 Celiac plexus parasagittal anatomy Distal to the splenic flexure of the large intestine, the visceral-nociceptive fibers of the remaining colon (and of pelvic viscera) travel in part through…
