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

Acute pain is common among patients at the emergency department and is still not being treated adequately. Repeated measurement and documentation of pain is essential for adequate pain treatment. The patient determines how much analgesia is needed. Pharmacological pain relief should not be delayed during the diagnostic process, not even in cases of abdominal pain. Opioids play a central role in the treatment of acute pain. Opiophobia is not justified. Adequate pain relief started at the emergency department must be continued throughout both hospital admission and discharge to home.
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PMID:[Acute pain at the emergency department: better treatment required]. 2126 7

Antiphospholipid syndrome is a systemic autoimmune disease with thrombotic tendency. Consensus guidelines for pregnancy with antiphospholipid syndrome recommend low-dose aspirin combined with unfractionated or low-molecular-weight heparin because antiphospholipid syndrome causes habitual abortion. We report a 36-year-old pregnant woman diagnosed with antiphospholipid syndrome receiving anticoagulation treatment. The patient developed left abdominal pain and gross hematuria at week 20 of pregnancy. An initial diagnosis of left ureteral calculus was made. Subsequently abdominal-pelvic computed tomography was required for diagnosis because of the appearance of severe contralateral pain. Computed tomography revealed serious renal hemorrhage, and ureteral stent placement and pain control by patient-controlled analgesia were required. After treatment, continuance of pregnancy was possible and vaginal delivery was performed safely. This is the first case report of serious renal hemorrhage in a pregnant woman with antiphospholipid syndrome receiving anticoagulation treatment and is an instructive case for urological and obstetrical practitioners.
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PMID:Severe renal hemorrhage in a pregnant woman complicated with antiphospholipid syndrome: a case report. 2135 Jun 3

A 34-year-old woman, with intractable non-cancer abdominal pain was successfully treated with large amounts of oral morphine. Medical records showed that she had been suffering from severe upper right abdominal pain with nausea and vomiting for 11 years. The pain continued all day long and the breakthrough pain occurred sometimes accompanied by nausea and vomiting. Various medical examinations including psychosocial exploration had been done to explain her pain mechanism and vomiting but causes were unknown. Psychological examination revealed she had no mental problems. A year and 6 months, she felt severe pain never experienced at the same area and she was transferred and admitted to our clinic. We conducted the epidural morphine analgesia. Her pain responded to this treatment. The dose of morphine was gradually increased and she was free from pain at the dose of 30 mg x day(-1) epidural morphine. With decreasing pain, her nausea and vomiting also diminished. This epidural dose could be clinically converted into 1,440 mg oral morphine. She was seen at our clinic twice a month for her pain condition and for checking the blood morphine level. In spite of large amount of morphine intake, no accumulation of blood morphine, M-6-G, and M-3-G levels was recognized.
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PMID:[Case of non-cancer abdominal pain successfully treated by a large amount of oral morphine]. 2138 72

Methylnaltrexone is a methylated form of the mu-opioid antagonist naltrexone that blocks peripheral effects of opioids without affecting centrally mediated analgesia. The authors conducted a 3-month open-label extension trial of methylnaltrexone in patients with advanced illness and opioid-induced constipation (OIC). Following completion of a 2-week double-blind (DB) trial, 82 patients with OIC who did not respond to laxatives received subcutaneous (SC) methylnaltrexone as needed for up to 3 months. Patients received 0.15 mg/kg as a first dose, adjusted to 0.3 mg/kg or 0.075 mg/kg as needed (maximum of one dose per 24 hours). Mean laxation response (rescue-free bowel movement within 4 hours) rates (DB phase, months 1, 2, 3 open-label phase) were 45.3%, 45.5%, 57.7%, and 57.3%, respectively, for patients treated with DB methylnaltrexone and 10.8%, 48.3%, 47.6%, and 52.1%, respectively, for patients treated with DB placebo. Median time to laxation among responders was 45 minutes (range 0-4 hours) for all doses. Approximately 50% of patients reported improvement in constipation distress. Patient and investigator global clinical impression of change scores also improved. There were minimal changes in pain scores and opioid withdrawal symptoms. Adverse events included abdominal pain and nausea, mostly mild or moderate in severity. SC methylnaltrexone administered PRN (as needed) for up to 3 months continued to rapidly induce laxation in advanced illness patients with OIC.
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PMID:Methylnaltrexone for opioid-induced constipation in patients with advanced illness: a 3-month open-label treatment extension study. 2165 61

Abdominal pain and spasms are common symptoms in organic gastrointestinal diseases, yet are associated with significant unmet need in terms of recognition and treatment. The aim of this review was to help physicians to understand the pathophysiology and impact to patients of abdominal pain and spasms in inflammatory bowel disease (IBD) and biliary diseases. This may in turn help in the selection of the most appropriate treatment to improve patients' overall daily functioning and quality of life in addition to reducing health resource utilization. Relative to the healthy colon, the mechanisms of pain generation in IBD include peripheral sensitization, including visceral hypersensitivity, central processing and modulation, and associated features or modifiers. Calcitonin gene related peptide, substance P, transient receptor potential vanilloid type, and serotonin biosynthesis in the colon are implicated in these processes. For biliary pain, important factors include pressure change or high pressure in the gallbladder, gallbladder ejection fraction, and change in the shape of gallbladder. Pain management is multifactorial and may involve psychological and physical methods and drugs (nonsteroidal anti-inflammatory agents, opioids, antispasmodics, with regional and epidural analgesia reserved for severe cases) after appropriate risk-benefit assessment. Antispasmodic agents may be effective in selected patients with IBD, especially those who are in remission and have mild/moderate chronic pain.
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PMID:Understanding and treating abdominal pain and spasms in organic gastrointestinal diseases: inflammatory bowel disease and biliary diseases. 2166 26

For drug therapy a differentiation of acute and chronic pain is essential. In emergency situations of acute abdominal pain a fast diagnosis is mandatory. Analgesia should be provided as soon as possible. The different groups of analgesics should be used according to their known effects, side effects and contraindications. Postoperative pain after abdominal surgery has to be considered as a special condition of acute abdominal pain. Main treatment options are non opioid analgesics and opioids. Opioids can be administered intravenously via patient controlled analgesia (PCA) devices. In major abdominal surgery neuroaxial analgesia, preferentially administered via an epidural catheter provides excellent pain relief with positive impact on gastrointestinal motility and patients' recovery. Because of difficulties to allocate chronic abdominal pain to a specific organ, causal treatment often turns out to be difficult. Peripheral and central sensitization, as well as an alteration of the endogenous pain modulation comes to the fore in these chronic pain conditions. Co-analgesics like anticonvulsants and antidepressants are utilized to reduce sensitization and improve the endogenous pain modulating system. Non drug approaches and alternative treatment options might be useful. In contrast, orally or transcutaneously administered opioids are the principal corner stone for the treatment of cancer pain.
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PMID:[Drug therapy of acute and chronic abdominal pain]. 2179 93

A 69-year-old woman (156 cm, 53 kg) underwent a Miles' operation, total hysterectomy, resection of vagina, and thigh flap to vulva for rectal cancer. Before general anesthesia, an epidural catheter was inserted at T11-12 interspace, and 1.5% mepivacaine 7ml was administered. Sensory block level spread from T4 to L1. Anesthesia was induced with propofol and maintained with sevoflurane in air oxygen mixture. Operation was performed uneventfully. After the operation, postoperative analgesia was achieved with patient-controlled epidural analgesia (PCEA). The epidural solution of 0.06% ropivacaine with 4 microg x ml(-1) fentanyl and 20 microg x ml(-1) was connected to a PCA pump (i-Fuser, JMS, Japan) that was programmed as an 8 ml initial bolus, 4 ml x hr(-1) basal infusion, 2 ml bolus dose, and 10-min lockout interval. Although abdominal pain was well controlled by PCEA, intractable pain in the pelvic nerve region existed. Patient-controlled intravenous analgesia (IV-PCA) with fentanyl, ketamine, and lidocaine was added to PCEA. Then excellent pain relief was obtained without any side effects such as nausea, vomiting, drowsiness, and respiratory depression. It could be useful to use IV-PCA together with PCEA when wide spread postoperative analgesia is necessary.
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PMID:[Patient-controlled epidural analgesia combined with patient-controlled intravenous analgesia for postoperative analgesia after Miles' operation for rectal cancer]. 2186 22

A 25-year-old female presented to the emergency department (ED) with a 1-day history of crampy left iliac fossa (LIF) abdominal pain. It was associated with both nausea and vomiting. On examination she was tender in the LIF with some guarding. Her observations were satisfactory and she was apyrexial. Urine dipstick and pregnancy stick were negative. The case was a diagnostic quandary. On ultrasound scan (USS) no acute gynaecological problems were found. Computed tomography (CT) of the abdomen showed epiploic appendagitis. This was managed conservatively with analgesia and antibiotics and the patient was discharged home pain free. She was followed up in the general surgical clinic 1 week later where she continued to be symptom free. She was discharged from general surgical care.
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PMID:Epiploic appendagitis. 2186 38

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder involving abdominal pain and bowel dysfunction. IBS pain symptoms have been hypothesized to depend on peripheral and central mechanisms, but the pathophysiology is still unclear. The aim of the present study was to assess the contribution of cerebral and cerebrospinal processes to pain inhibition deficits in IBS. Fourteen female patients with diarrhea-predominant IBS (IBS-D) and 14 healthy female volunteers were recruited. Acute pain and the nociceptive withdrawal reflex (RIII reflex) were evoked by transcutaneous electrical stimulation of the right sural nerve with modulation by hetero-segmental counter-irritation produced by sustained cold pain applied on the left forearm. Psychological symptoms were assessed by questionnaires. Shock pain decreased significantly during counter-irritation in the controls (P<0.001) but not in IBS patients (P=0.52). Similarly, RIII-reflex amplitude declined during counter-irritation in the controls (P=0.009) but not in IBS patients (P=0.11). Furthermore, pain-related anxiety increased during counter-irritation in IBS patients (P=0.003) but not in the controls (P=0.74). Interestingly, across all subjects, counter-irritation analgesia was positively correlated with RIII-reflex inhibition (r=0.39, P=0.04) and negatively with pain-related anxiety (r=-0.61, P<0.001). In addition, individual differences in counter-irritation analgesia were predicted independently by the modulation of RIII responses (P=0.03) and by pain catastrophizing (P=0.01), with the latter mediating the effect of pain-related anxiety. In conclusion, these results demonstrate that pain inhibition deficits in female IBS-D patients depend on two potentially separable mechanisms reflecting: (1) altered descending modulation and (2) higher-order brain processes underlying regulation of pain and affect.
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PMID:Decreased pain inhibition in irritable bowel syndrome depends on altered descending modulation and higher-order brain processes. 2188 72

Abdominal pain can be disabling in patients with gastroparesis. The pathogenesis of pain in these individuals is poorly understood. Agents commonly used in clinical practice, including tricyclic antidepressants, gabapentin, and pregabalin, have remained largely unsatisfactory in treating this pain. We report the case of a 50-year-old woman presenting with chronic unrelenting abdominal pain due to severe diabetic gastroparesis that was managed successfully with coeliac plexus block with local anaesthesia and steroid injection. Adequate analgesia was achieved and maintained for 10 weeks following the coeliac plexus block, which allowed elimination of opiate requirements for pain management (and avoidance of narcotic associated constipation), continuation of percutaneous endoscopy jejunostomy tube feedings, and avoidance of long term parenteral nutrition.
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PMID:Coeliac plexus block in the management of chronic abdominal pain due to severe diabetic gastroparesis. 2212 92


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