CHRONIC ABDOMINAL PAIN

AN INTERVENTIONIST’S
PERSPECTIVE

PROF DR. MUHAMMAD SALEH KHASKHELI

PROFESSOR & HEAD
DEPT OF ANAESTHESIOLOGY, SICU & PAIN
CENTER PUMHSW SBA
 OUTLINE

• Introduction
• Etiology
• Management Modalities
• Regional Techniques
• Conclusion
 PAIN
• Pain is an unpleasant sensory and
emotional experience associated with
actual or potential tissue damage, or
described in terms of such damage.

International Association for the Study

of Pain (1979)
PROPOSED NEW DEFINITION
OF PAIN
• An aversive sensory and emotional
experience typically caused by, or
resembling that caused by actual or
potential tissue injury.

International Association for the Study

of Pain (Aug 7, 2019)
 INTRODUCTION
• Most common presenting symptom
• Chronic abdominal pain can have multiple
etiologies ranging from focal sites of
inflammation to idiopathic systemic
diseases.
• It can be of visceral, neuropathic,
musculoskeletal, related to cancer or
psychogenic origins
 ETIOLOGY
• Infectious-inflammatory pain states
• Functional pain states
• Musculoskeletal origin
• Abdominal pain of chest-related origin
• Generalized disease origin
• Due to cancer
• Gynecological pain
• Neurologic origin
• Pain of psychological origin
• Pain of uncertain origin
Silen W. Abdominal pain. In: Kaspar DL, Fauci AS, Longo DL et al. (eds). Harrison’s principles of internal medicine, 16th edn.
New York: McGraw-Hill, 2005: 82–4.
https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-019-2026-7
 General evaluation of abdominal
pain
• A detailed clinical history
• Palpation of the abdomen
• Auscultation of bowel sounds
• Neurological examination
• Basic laboratory examinations
• Radiographic evaluations
• Other tests

Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: a frequently overlooked problem: practical approach to diagnosis and
management. Am J Gastroenterol. 2002;97:824–30.
 MANAGEMENT MODALITIES
Interventional procedures
• Pharmacological treatment
• Nerve blocks with local anesthetics and
steroid or a neurolytic solution
• Radiofrequency ablation
• Neuromodulatory techniques
• Multidisciplinary treatment (psychological
interventions, physical or occupational
therapy or modalities such as
acupuncture).

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, ISSN: 1542-7714, Vol:
6, Issue: 9, Page: 978-82 publication Year2008
 PHARMACOLOGICAL
INTERVENTIONS
• Acetaminophen
• Nonsteroidal Anti-inflammatory Drugs
(NSAIDs)
• Antidepressants
• Neuroleptics
• Antispasmodics & Muscle Relaxants
• Corticosteroids
• Anticonvulsants
• α 2 -Adrenergic Agonists
• Local Anesthetics
• Opioids
Camilleri, Michael. (2006). Management of patients with chronic abdominal pain in clinical practice. Neurogastroenterology and motility : the official
journal of the European Gastrointestinal Motility Society. 18. 499-506. 10.1111/j.1365-2982.2005.00744.x.
 ANALGESIC LADDER

https://www.researchgate.net/figure/New-adaptation-of-the-analgesic-ladder_fig2_258112804
 PROCEDURAL THERAPY
Diagnostic & Therapeutic Blocks
• Thoracic epidural blockade
• Fluoroscopy, Ultrasound and CT-guided
celiac plexus block and neurolysis with
alcohol or phenol
• Superior and/or inferior hypogastric
plexus block :Fluoroscopy, Ultrasound,
Computed Tomography guided
 CELIAC PLEXUS BLOCK

Kaufman M, Singh G, Das S, Concha-Parra R, Erber J, Micames C, et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus
neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol. 2010;44:127–34.
 Plancarte’s Technique of
Superior Hypogastric Block and
Neurolysis

https://link.springer.com/chapter/10.1007/978-3-319-99124-5_181
 CONCLUSION

• Chronic pain with abdominal, groin, or

perineal localization is a common clinical
entity with multiple etiologies both
known and unknown.
• All therapies are both disorder
dependent and patient dependent.