Chronic abdominal pain is pain that is present for more than 3 months either continuously or it may come and go. By the time patients are referred to a pain clinic it has been present for 3 months or more and they would have been investigated by their GP/Specialist. Typical disorders that cause abdominal pain have already been ruled out. It does mean that only about 10% of them have a specific physical disorder. The remaining 90% have what is called functional abdominal pain.
Functional pain is real pain that exists for more than 6 months and occurs with no evidence of a specific physical disorder or flare up of that disorder. For example, you might have had a bad stomach infection or surgery but repeated flare ups with no evidence of recent infection or scarring etc would be classified as functional. Even most forms of IBS do have a functional element. Functional pain can be severe and typically interferes with the person’s life. What we mean by functional is that the nerves of the digestive tract may become oversensitive to sensations (such as normal movements of the digestive tract). Genetic factors, life stresses, personality, and underlying mental disorders (such as depression or anxiety) may all contribute to worsening of this functional pain.
Pelvic pain is more common in women than men. While common causes of acute pelvic pain include pelvic inflammatory disease (PID), urinary tract infection (UTI), ectopic pregnancy, and rupture of ovarian cysts, chronic pelvic pain can be due to various other problems like endometriosis, PID and dense adhesions. It can again be classed as acute or chronic. It would significantly impact on a woman’s quality of life as well as carrying a heavy economic and social burden.
In addition, past pelvic or abdominal surgery, or trauma during childbirth may contribute to the start of chronic pelvic pain. Social and psychological factors are strongly associated with chronic pelvic pain. Often the same principle of oversensitive nervous system from the pelvis can contribute to the worsening of the pain and tightening of the pelvic muscle floor and these can respond to some medications or interventions and specialised physiotherapy.
How can the pain consultant help?
Pain consultants often work as part of multidisciplinary teams and we have access to a good network of physiotherapists/psychologists and specialised pelvic rehab therapists who are able to work with us and our patients and create a personalized strategy that is very specific for the patient’s pain. Our main aim will be to restore function and range of movement and combining invasive injections with other holistic treatment strategies that include nutrition advice, medication, acupuncture, massage and physio can significantly improve the chance of success and long-term pain relief.
Our first aim is to undertake an accurate diagnosis and provide holistic management from the first presentation. This will help to reduce the disruption caused by multiple referrals, investigations and operations.
Injection treatments include piriformis muscle injections, trigger point injections into the pelvic floor, Botox injections into the tight muscle floor, organising for biofeedback therapy, pudendal nerve block, impar ganglion block and superior hypogastric plexus block.