Chronic Lower Abdominal Pain
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03-02-2024 1:55am#1
21/Male
Started last April, steadily getting worse over time. Usual suspects ruled out, IBS, IBD, Appendicitis etc.
Had many tests. CTs, X-rays, bloods, urine, colonoscopy, gastroscopy, MRI next week. Nothing of note.
Had a Rhizotomy (nerve blocking procedure) in October, no improvement.
Have seen two pain management specialists now, and been on many meds since this started. Paracetamol, Ibuprofen, Vimovo, Solpadol/Tylex, Codeine, Tramadol, Pregabalin, Amitriptyline, Colpermin, Buscopan, Buprenorphine patches, Versatis (Lidocaine) patches, Tapentadol (current medication) and low dose Oxynorm (Oxycodone).
Other than it being labelled chronic, and most recently after seeing a pain specialist as "Visceral" pain, I've got nothing. No answers whatsoever.
As far as pain management goes, I'm in a crappy position. The Palexia (Tapentadol) I'm on now helps a bit but, my heart doesn't like it. It causes painful palpitations. Discussed this with my GP, who listened to my heart and lungs, both were fine despite the fact that it was a hurting as he was listening. ECG too.
After I had the Rhizotomy, the pain management specialist who did the procedure prescribed the low dose Oxynorm mentioned above. No great surprise, it worked phenomenally well. I was in virtually no pain. I could not believe the relief. Due to the dose (5mg I think) there was no dizzying high or anything like that, just pure pain relief. I was so much more 'me' that week. More walking around, eating better, less time in bed, and when I was, I was sleeping well. The only side effect being constipation but, that happens with all the opioids/opiates. Managed with various laxatives.
I find myself between a rock and a hard place here. Right now, there is no diagnosis in sight, and I'm in awful pain all the time. As I type this, I'm in what I'd have previously described as 'right I'm going to A&E' pain. But the reality is, no one down there is able to help with this. Hook me up with an IV drip with fluids, paracetamol, buscopan, Ibuprofen, take blood and urine, told all is fine and I can leave. And that's after anywhere from 4 to 16 hours of waiting to even get in.
My GP is a great guy, younger, easier to talk to, no rushing you out the door, genuinely listens, and has been very, very helpful throughout all of this. Be it letters for A&E, prescriptions, advice, many calls back at my request. He's been great. The one problem I have is, he's very anti Morphine, which I assume is due to a combination of the addiction risk (already dependant on Tapentadol, another opioid so...) and my age. I do not want to be on Morphine, who the hell does? But Jesus Christ it worked phenomenally well for me when I was taking it that week. With no fix in sight, it's incredibly hard not to want to be on it until something is found. I have asked previously if he could put me back on it but was denied. I then asked about Hydrocodone because it's stronger than Tapentadol, but weaker than Oxycodone, but it's still Morphine, so no. I know you shouldn't ask a doctor to put you on something specific but, I was, and am desperate.
Ultimately there's no question in this post, was just venting really but, if anyone has any advice at all I'd be more than happy to chat.
Thank you
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Comments
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I am not a doctor but seen a YouTuber who also suffered with chronic abdominal pain but not all the time and was getting everything checked. he was in hospital about a week ago with gall bladder removed and is recovering.
He is taking it easy for the moment. Hope you get to the route of your issue.
No idea if Cbd or Cannabis might benefit you.
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Nice to hear that worked out for them.
Have tried CBD, but no help sadly. No Cannabis though, really not a fan of it personally. No problem with others using it though. I know it's a contentious topic.
Thanks a mil!
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Is it your diet ? Are you allergic to something ? Are you exercising, stretching regularly ? Drinking enough water ? Is is some kind of anxiety or mental health triggered issue ?
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You have my huge sympathy. I've had pain, abdo and loin for four months, like you all tests have been normal so far but still ongoing. I thought a restrictive diet was working, but then it didn't any more. It's immensely unpleasant and worrying, isn't it? I'm much older than you but was always fit and active and this has taken the joy out of life.
As a retired medic I totally understand your GP's reluctance to prescribe opiates. I know from taking the occasional one for post-op pain that they can give blissful relief, but it truly comes at a cost. And I can honestly say that despite my post op stash of palexia and solpadol, I'm not tempted to take them for now. They really are hugely addictive and harmful, best kept for 48 hours post-op, or the occasional acute severe (not chronic) pain, or end-of-life care.
i'm so sorry that at your age no one has been able to find a treatable cause or an answer. The MRI may come up with something, but if not, just thinking outside the standard medical box - have you tried acupuncture? Or hypnotherapy? Both will cost you obviously, and results will depend on finding a really good, experienced practitioner. But at least it's good to have a Plan B.
Wishing you the very best.
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I tried a few things in my own time to figure out if it was something diet related. Cut out wheat for a couple of weeks, same with dairy. Neither provided any relief. Other than hayfever, no allergies either. I can't do any kind of exercise or stretching because of the pain. I'm very mobility restricted. Anything more than walking (with a cane) is very painful. I do drink plenty of water. Have a glass litre bottle that I go through multiple times a day. As for mental health related things, the posibility of somatoform pain has been mentioned a couple of times, and I'm rather hoping it isn't that. Otherwise, my fear is that this will go on for a long time, and the 'treatment' will be antidepressants, talking therapies etc. I don't mind talking therapies, but in the last 3-4 years I've been on plenty of them across various classes. I do not want to be on one again, they absolutely suck the life out of you. Or they do for me anyway. Not to mention the fact that they wouldn't provide any kind of sorely needed pain relief in the short term.
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I'm sorry to hear about your pain. It really is worrying when you have no idea why it's happening.
I do understand the addictive nature of opioids/opiates, and their ill effects, I really do. They're not something that I'm super happy to be on, but right now they're the only thing providing some kind of relief. Other non-opiate painkillers, NSAIDs etc haven't touched my pain whatsoever. My 'want' for something like Oxycodone or even Hydrocodone, doesn't stem from a desire to be off my trolley on a lovely buzz (good luck convincing a medical professional of that at my age) but rather just the pure pain relief. It's an absolutely miserable existence being in so much damn pain all the time with no obvious cause. I can't even play with my younger siblings (5 and 6) because of this. Beyond going out to make tea or food, they barely see me these days. Even the tea and food is looked after by my mother or brother (different sibling) 90% of the time because I'm in that much pain.
I really do hope the MRI shows something too, this feels like it's been going on forever. I haven't tried acupuncture or hypnotherapy. Neither of which I'm against at this point.
Thank you, same to you.
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Hi OP,
I am sorry to hear of your struggle with pain and the difficulties in getting either an actual diagnosis or adequate control of your pain.
I know how you're feeling and I'm a few years ahead of you on the chronic pain journey.
My own kicked off in 2019 and is still ongoing. It was originally diagnosed as a thrombosed varicocele that had entrapped a nerve. I thought brilliant, they can cauterise and I can move on.
That was in June 2019, there's been no surgery as of yet. Despite seeing multiple Urologists both in Ireland and UK. The Urology docs have acknowledged the varix, and raised the possibility of post vasectomy nerve damage too but, they are all adamant it's a neurological issue.
I am seeing a Neuro-Urologist in Cork at the end of the month and hopefully he can offer a way ahead.
On the topic of pain control. I totally empathise with your description of the difference Oxynorm can make. I didn't actually realise just how much pain I was in until it stopped.
I was 1st prescribed it in late 2019 and it is still part of my pain control regime. It is a dangerous step if not managed properly. I have both Oxynorm & Oxycontin available after I saw the pain management team in UHL.
Oxycontin gives me both a longer period without pain and doesn't have the euphoria I find comes with Oxynorm. I don't take opioids everyday, they are reserved for bad days or those days when I "have" to do something.
It may sound strange but I'm quite proud of the fact that in all the time I've had it available to me? That my original dosage of Oxycontin 10mg and Oxynorm 5mg still do the job without my needing to bump the dose.
Now aside from the opioids, the world of neuropathic meds and their use arises. Some such as Lyrica or Gabapentin can really dial down the background pain. It's a discussion to have with whomever is managing your pain control.
My day to day pain control is currently Gabapentin, Duloxeitine and amitriptyline as my daily maintenance dose, with opioids if needed. It is quite a lot to get used to and I'm lucky enough that my GP is very helpful.
I also see an interventional radiologist for rhizotomy. 3 nerves usually done the Ilioinguinal, genitofemoral and hypogastric. The procedure is usually steroid and anaesthetic injected along the nerve sheath, with an electrode then placed and the nerve cooked.
I always find the steroid & local give a good degree of relief that lasts a couple of days. Then it worsens again before the sheath adjusts. Unfortunately in my case the ablation is hit or miss. I've had 11 or so at this stage and about a 60% success rate 😕
I only had my last rhizotomy on the 25th of Jan and the Doc suggested that I consider a neurectomy. That is cutting the sensate nerves involved in the hope that it solves the problem.
Now I would say that's a suggestion after over 5yrs of my symptoms. I'm not at all suggesting it's what you seek. In my time dealing with this, I've seen a lot of young men encounter similar symptoms and 3/4 months of agony before it resolves. My GP has said quite a lot of cases are unresolved epididymitis and a course of antibiotics is always his 1st line treatment if there are no other symptoms.
I am currently writing this reply to you with my left leg raised and an ice pack on the back of my scrotum and perineum. That's how I have pain free days without drugs😕
Not a great place to be, but I know I'll get it resolved and get the rest of my life back.
I know you will too!
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If it is intestinal pain (ileum/colon)it is pretty much always cramping in nature and often related to alteration in bowel habit. You’ve had the colonoscopy, so it rules that out. However small intestine is unreachable by normal scoping methods, and CT is the usual diagnostic. Guessing appendicitis/walled off chronic abscess ruled out too?
I used to have ulcerative colitis before removal of my colon, and had chronic pain over upper right side for a long time, sometimes relieved with laxatives. Turned out adhesions from a silent rupture and chronic abscess formation had kinked that area of my colon. Adhesions can cause havoc in the guts.
Presumably, prostate, bladder, testes etc have been examined? And kidney stones ruled out, they can cause overwhelming pain which can come and go when stones get lodged in the ureters?
I really hope you get an answer which can lead to a once & for all solution.
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If pain is on left side, it could be liver issue. You don't mention that in the OP.
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The liver is on the upper right side though.
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Two things to consider for chronic pain are vitamin D status and supplementation with Palmitoylethanolamide (PEA).
https://www.mdpi.com/1422-0067/18/10/2170
https://link.springer.com/article/10.1007/s10787-013-0191-7
The weather last summer has probably magnified the effects of vitamin D deficiency and its a simple blood test to find out. 3000iu/day is probably the minimum to get back to a reasonable level in a reasonable time.
PEA is a derivative of egg yolk and something produced naturally in the body so it is just augmentation. Not too common here as a supplement but can be bought online from Europe and works best in micronised form and in conjunction with the flavonoid Luteolin. Some preparations already have the two together.
Also anything increasing inflammation will contribute so low inflammatory diet, low stress, moderate exercise etc. should help.
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