Pain Conditions
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      1. VCT Resource Library
      2. Pain Conditions

      Chronic Abdominal Pain

      Brief Overview: Chronic abdominal pain is ongoing or recurrent abdominal discomfort lasting ≥3–6 months. It may be constant or intermittent and can arise from gastrointestinal, urologic, gynecologic, musculoskeletal, neurologic, or psychosocial causes. In adults, multiple factors often overlap, making evaluation and management complex.

      Prevalence: According to MSD Manual, “About 2% of adults, predominantly women, have CAP.”

      Etiology:

      • Functional GI disorders: irritable bowel syndrome (IBS), functional dyspepsia.
      • Structural causes: peptic ulcer disease, gallstones, hernias, diverticulitis.
      • Chronic inflammation: inflammatory bowel disease (Crohn’s, ulcerative colitis).
      • Other systems: chronic pancreatitis, interstitial cystitis, gynecologic conditions (in women).
      • Neuropathic/central sensitization: after surgery or injury.
      • Psychological factors: anxiety, depression, history of trauma.

      Risk Factors:

      • Older age (higher prevalence of GI, vascular, and cancer-related causes).
      • Female sex (IBS, pelvic causes).
      • History of abdominal surgery (adhesions, nerve entrapment).
      • Family history of GI disease.
      • Chronic NSAID use (ulcer risk).
      • Stress, anxiety, depression.

      Commonly Associated Conditions:

      • Irritable bowel syndrome (IBS).
      • Gastroesophageal reflux disease (GERD).
      • Peptic ulcer disease.
      • Diverticulitis or diverticulosis.
      • Gallbladder disease.
      • Chronic pancreatitis.
      • Anxiety, depression, sleep disorders.

      Common Medications:

      • Analgesics: acetaminophen, NSAIDs (with caution)
      • Antispasmodics: dicyclomine, hyoscyamine (for IBS)
      • Antidepressants (low-dose TCAs, SNRIs): modulate pain pathways
      • Proton pump inhibitors (PPIs): GERD, peptic ulcer disease
      • Antibiotics: rifaximin for IBS-D
      • Laxatives or stool softeners: if constipation-related
      • Antidiarrheals (loperamide): if diarrhea-related
      • Neuropathic pain agents: gabapentin, pregabalin (for nerve-related abdominal pain)
      • Opioids: generally avoided; may worsen abdominal pain and constipation

      Common Labs, Imaging, and Tests:

      • Labs: CBC, CMP, ESR/CRP, amylase/lipase, liver function tests, stool studies.
      • Endoscopy/colonoscopy
      • Imaging: ultrasound, CT, MRI
      • Functional tests: gastric emptying, manometry (selected patients)
      • Screen for depression/anxiety as contributors

      Common Symptoms:

      • Persistent or recurrent abdominal pain (dull, cramping, or sharp)
      • Bloating, fullness, or discomfort after meals
      • Changes in bowel habits (constipation, diarrhea)
      • Nausea, heartburn, or indigestion
      • Pain may be associated with stress or certain foods
      • Sleep disturbance, fatigue, mood changes

      Common Treatments:

      • Non-Pharmacologic:
        • Dietary modification: low-FODMAP, avoid trigger foods (fatty, spicy, caffeine, alcohol)
        • Fiber optimization: depending on constipation vs diarrhea
        • Physical activity: improves motility and reduces stress
        • Stress management: CBT, mindfulness, relaxation techniques
        • Heat therapy: heating pad for comfort
      • Pharmacologic:
        • Targeted therapy based on underlying cause (PPIs, antispasmodics, antidepressants, laxatives, antidiarrheals, etc.)
        • Neuropathic pain agents if central sensitization suspected
      • Interventional:
        • Nerve blocks or neuromodulation for refractory neuropathic abdominal pain
        • Surgery if structural disease identified (hernia, gallstones, obstruction)

      Physical Findings:

      • May have abdominal tenderness (localized or diffuse)
      • Bloating, visible distension
      • Guarding or rebound tenderness → more concerning (requires urgent referral)
      • Otherwise, may appear well despite significant reported pain

      Potential Complications and Contraindications:

      • Complications:
        • Malnutrition, weight loss
        • Depression, anxiety, social isolation
        • Medication overuse (NSAIDs, opioids)
        • Functional decline, reduced independence in seniors
      • Contraindications:
        • NSAIDs: avoid with GI bleed, kidney disease, or cardiovascular risk
        • Opioids: not recommended long-term; may worsen abdominal pain (narcotic bowel syndrome)
        • Antispasmodics: use cautiously in elderly (anticholinergic side effects)

      General Health and Lifestyle Guidance:

      • Eat smaller, more frequent meals.
      • Stay adequately hydrated. Ask your healthcare provider what your fluid intake recommendations are.
      • Keep a food/symptom diary to identify triggers.
      • Increase dietary fiber gradually if constipated, as advised by your healthcare provider.
      • Avoid excessive caffeine, alcohol, or greasy foods.
      • Gentle exercise (walking, yoga) to improve motility and reduce stress. Ask your healthcare provider what exercises are recommended for you.
      • Practice relaxation or mindfulness to manage stress-related pain.
      • Maintain good sleep hygiene.

      Suggested Questions to Ask Patients:

      • How long have you had abdominal pain, and is it constant or intermittent?
      • Can you describe the pain (sharp, cramping, dull)?
      • Does pain relate to meals, bowel movements, or stress?
      • Have you noticed changes in bowel habits?
      • Have you had weight loss, fever, or blood in your stool?
      • What medications or home remedies do you use for the pain? Do they help?
      • How does the pain affect your daily activities, mood, or sleep?
      • Have you identified any food triggers?

      Suggested Talking Points:

      • Chronic abdominal pain can come from many different causes — sometimes more than one at the same time.
      • Simple changes in diet, activity, and stress management can sometimes make a big difference.
      • It’s important to avoid overusing pain medicines like NSAIDs or opioids, as they can cause more problems.

      Keeping a diary of symptoms and food intake can help your care team find patterns.

      • If you ever notice red flag symptoms like sudden severe pain, vomiting blood, or black stools, call your doctor immediately. Ask your doctor for other alarm symptoms and advice for when you should seek urgent/emergency care.

      Sources:

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.