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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Celiac plexus block has long been used to provide analgesia for upper abdominal pain. In particular, neurolytic celiac plexus block has been advocated for pancreatic cancer pain. In this article, recent advances clarifying the role and limitations of neurolytic celiac plexus block are reviewed. Neurolytic celiac plexus block provides persistent augmented analgesia when used as an adjunct to systemic opiates, but does not reliably decrease opiate requirements. In addition, neurolytic celiac plexus block may prolong survival, but the data supporting this remain controversial. The optimal technique for accomplishing neurolytic celiac plexus block remains undetermined.
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PMID:Celiac plexus block for visceral pain. 1649 26

The gastroenterologist deals frequently with painful conditions and suffering patients. Performing regular pain assessments and applying basic pain medicine principles will augment the care of patients in pain. Percutaneous-guided pain therapy techniques play a role in the multidisciplinary approach to pain medicine. Systemic opioid analgesia is the primary means of controlling cancer pain. However, 10% to 15% of cancer patients may need additional interventions to control pain. Sympathetic ganglion nerve blocks with neurolytic agents such as alcohol or phenol are reserved mostly for cancer pain. The efficacy and safety of these tools are validated by several decades of clinical application and published studies. Although the procedures are operator-dependent, in the hands of experienced clinicians, patients achieve sustained relief in the majority of cases. Although these techniques have been attempted in some benign conditions,such as chronic pancreatitis, with limited success, studies of newer imaging localization techniques such as endoscopic ultrasonography may expand future indications. Patients of the gastroenterologist who experience malignant abdominal pain may benefit from referral for percutaneous-guided pain control techniques.
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PMID:Percutaneous-guided pain control: exploiting the neural basis of pain sensation. 1653 Jan 19

Acute intermittent porphyria is a rare autosomal dominant hereditary inborn error of metabolism of the heme biosynthetic pathway that can be exacerbated through a multitude of environmental factors. This article is a case study describing the pathophysiology, clinical presentation management, and exacerbation prevention of acute intermittent porphyria. The disease is clinically manifested with severe abdominal pain, confusion, and seizures which may be life threatening. Specific treatment with heme preparations should be instituted as soon as increased excretion of porphobilinogen through urine sampling is confirmed. Supportive treatment includes opiate analgesia, monitoring for and treating complications such as hypertension and hyponatremia. Follow-up should include family counseling regarding genetic defects and individual counseling regarding lifestyle changes including avoidance of environmental factors that have been implicated in the exacerbation of the disease.
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PMID:Abdominal pain due to acute intermittent porphyria: when is the sound of hoof-beats not horses, but zebras? A case report. 1672 Nov 83

The case is presented of a 66 year old woman who attended the emergency department with severe abdominal pain subsequent to a bout of coughing, following a week's history of productive cough. She was known to have chronic obstructive pulmonary disease and was also on warfarin for recurrent deep vein thromboses. She had no history of ischaemic heart disease. She was found to have a rectus sheath haematoma and an international normalised ratio of 7.7, and admission was arranged for coagulation control and analgesia. However, a routine electrocardiograph (ECG) demonstrated an ST elevation pattern consistent with an acute inferior infarction. Subsequent ECGs showed no ST elevation, although the axis and chest lead QRS morphology remained the same throughout the first 12 hours. Over the next three days, R wave progression decreased in the chest leads. Troponin I at admission and 24 hours later were both <0.2 ng/ml. ECG changes compatible with acute myocardial infarction have been reported in association with a number of non-cardiac presentations; however, to our knowledge, it has never been reported in relation to a rectus sheath haematoma. We speculated on the possible mechanism of such "pseudo myocardial infarction" and the importance of treating the patient, not the ECG.
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PMID:Pseudo myocardial infarction. 1685 85

Patients will commonly seek medical attention for refractory abdominal pain. The many causes of abdominal pain include pathologies of the gastrointestinal, genitourinary, musculoskeletal, and nervous systems. Unfortunately, a large number of patients will develop chronic abdominal pain that is recalcitrant to definitive therapies and nonspecific treatments such as cognitive-behavioral, physical, and pharmacologic therapies. Although spinal cord stimulation is classically used for neuropathic and ischemic conditions, a growing number of reports describe its efficacy in visceral disease. We describe our experience with spinal cord stimulation in two patients with refractory abdominal pain. Although the exact etiology in these complex patients is not defined, it is theorized that visceral hypersensitivity is at least one component. Finally, we will summarize the applicable literature in order to explain a possible mechanism of analgesia in visceral disease.
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PMID:The use of spinal cord stimulation in refractory abdominal visceral pain: case reports and literature review. 1714 97

Up to now, the studies in the world have demonstrated that CT-guided percutaneous neurolytic celiac plexus block (PNCPB) is an invaluable therapeutic modality in the treatment of refractory abdominal pain caused by cancer. Its efficacy of pain relief varied in reported studies. The main technical considerations which would affect the analgesic effects on abdominal pain included the patients' cooperation, needle entry approaches, combined use of blocking approaches, localization of the target area, dosage of the blocker, and so on. A success of PNCPB depends greatly on close cooperation with patients. The patient should be educated about the purpose and steps of the procedure, and trained of breathing in and breathing hold. The needle entry can be divided into the posterior approach and the anterior approach. The former one is the most commonly used in clinical practice, but the latter one is rarely used except in the cases that the posterior approach becomes technically difficult. Bilateral multiple blocking of celiac plexus and splanchnic nerves is often required to achieve optimal analgesia. The needle entry site, insertion course, and depth should be preselected and simulated on CT monitor prior to the procedure in order to ensure an accurate and safe celiac plexus block. The magnitude of analgesic effect is closely related to the degree of degeneration and necrosis of the celiac plexus. Maximally filling with blocker in the retropancreatic space is an indication of sufficient blocking. We also provided an overview of indications and contraindications, preoperative preparations, complications and its treatment of PNCPB.
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PMID:CT-guided percutaneous neurolytic celiac plexus block technique. 1715 2

Acute fatty liver of pregnancy is a rare, potentially fatal, complication of late pregnancy. The incidence is estimated at 1:7000-1:15000 pregnancies. Presentation is classically with malaise, nausea and vomiting, abdominal pain and rarely encephalopathy. Prolongation of laboratory clotting tests is an early feature. Ultrasound examination of the liver is performed to exclude biliary stasis. Rapid clinical deterioration may occur and urgent delivery should be organised. Anaesthetists form part of a multidisciplinary approach before, during and after delivery but there are few reports of anaesthetic involvement. One dilemma facing an anaesthetist called to assist in these cases is the potentially negative effect of general anaesthesia on hepatic encephalopathy versus the risks associated with regional anaesthesia in the presence of coagulopathy. Postoperative analgesia may also be complicated by impaired renal and hepatic function. We present three cases that occurred in our unit in a 6-month period illustrating the spectrum of disease severity and the successful use of different anaesthetic techniques to facilitate management including delivery.
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PMID:Acute fatty liver of pregnancy; three cases and discussion of analgesia and anaesthesia. 1727 81

We report the case of a patient presenting with midline abdominal herniation treated surgically followed by progressively growing abdominal pain resistant to conventional pain treatments. Epidural neurostimulation finally gave satisfactory results. We suggest that epidural neurostimulation can be a valuable tool in treating carefully selected patients with otherwise intractable pain. It is essential to rule out any local complication and to check that conventional analgesia is ineffective, that the psychiatric evaluation is satisfactory and that TENS provides a benefit in pain control. To our knowledge this is to be the first report of epidural neurostimulation for the treatment of chronic pain following repair of midline herniation.
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PMID:[Epidural neurostimulation for chronic pain following abdominal hernia repair]. 1733 59

This case report series describes eight patients (four patients with pancreatic carcinoma, one patient with hepatocellular carcinoma, one patient with gastric and rectal carcinoma, one with sigmoid colon cancer, and one with rectal cancer), whose abdominal cancer pain was treated with intravenous phentolamine infusion at 80 mg x day(-1) for 2 days. All but one of the patients had already been treated with opioids. All eight patients complained of severe abdominal pain; in five patients the pain radiated to the back, and there was associated anal pain in two patients. Analgesia was achieved in three patients; pain alleviation was obtained in four patients, but was not sustained in two of these four patients; and the treatment in one patient could not be judged for efficacy because epidural morphine was used together with the phentolamine. Adverse effects of phentolamine were tachycardia and/or hypotension.
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PMID:Intravenous phentolamine infusion alleviates the pain of abdominal visceral cancer, including pancreatic carcinoma. 1768 Jan 99

Models of stress-induced hyperalgesia state that exposure to stress can exaggerate subsequent pain experiences. Studies using both animal and human subjects have shown evidence for hyperalgesia as a function of stress [e.g., Jorum E. Analgesia or hyperalgesia following stress correlates with emotional behavior in rats. Pain 1988;32:341-48; Peckerman A, Hurwitz BE, Saab PG, Llabre MM, McCabe PM, Schneiderman N. Stimulus dimensions of the cold pressor test and the associated patterns of cardiovascular response. Psychophysiology 1994;31:282-90; Gameiro et al. Nociception and anxiety-like behavior in rats submitted to different periods of restraint stress. Physiol. Behav. 2006;87:643-49; Lucas et al. Visceral pain and public speaking stress: neuroendocrine and immune cell responses in healthy subjects. Brain Behav. Immun. 2006;20:49-56]. However, the role of stress in pediatric pain is not well understood. This study examined stress reactivity and pain tolerance and sensitivity in a population of children with Recurrent abdominal pain (RAP). Forty-nine children meeting criteria for RAP (28 female; mean age 13years; range 9-17years) were randomly assigned to either a condition in which they completed an experimental stressor paradigm (stress interview, serial subtraction task) followed by a pain task (cold pressor) or a condition in which they received the pain task prior to the stress tasks. Children who underwent the stress tasks before the pain task exhibited lower levels of pain tolerance than those who received the pain task first (p<.01); no differences were found between the two groups in pain threshold or pain intensity ratings. Further, pain tolerance was not related to individual differences in physiological reactivity (heart rate change) to the stressor. The present research demonstrates the first evidence of the occurrence of stress-induced hyperalgesia in a pediatric pain population.
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PMID:Effects of stress on pain threshold and tolerance in children with recurrent abdominal pain. 1771 18


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