A readily identifiable and treatable cause of chronic abdominal pain, although uncommonly found at a tertiary care setting, is of course a straightforward problem to address. More often, however, the gastroenterologist is left dealing with a patient who falls into one of the categories discussed in the previous section. In this regard, it is important to carefully examine the patient for an abdominal wall source as this may show a gratifying response to local neural blockade. Our approach is to identify a trigger point by digital examination, and inject a small amount of lidocaine or bupivacaine at the site of greatest tenderness elicited by the tip of the needle. Although the response may be short-lived, it can provide valuable information as a therapeutic trial. Further, many patients get long lasting relief after one or two injections alone. In those patients in whom relief is temporary, a 1:1 mixture of lidocaine and steroids (eg, triamcinolone) can be used. More ablative chemicals (eg, phe-nol)are best left to the anesthesiologist to administer.

Patients with chronic pancreatitis are increasingly being approached as problems in "plumbing" with various endo-scopic or surgical interventions designed to decompress what is thought to be a partially obstructive ductal system. This is discussed in greater detail elsewhere in the pancreatic and biliary sections of this book, but many of these patients remain in pain after these procedures. Other patients with chronic abdominal pain with no obvious cause are also rarely substantially pain free after 1 or more years of follow-up. In most of these cases a presumed cause of pain will have been diagnosed and treated, only to see the pain remain, or for a new type of pain to manifest itself elsewhere.

Palliation is therefore an appropriate goal, and, in most patients, it is achievable. In the following sections, we will describe the basic principles of our therapeutic approach common to both these categories of patients, realizing that some "tailoring" is appropriate depending upon the suspected underlying problem. In general, the therapeutic approach to functional forms of pain is similar to the multifactorial approach to other forms of chronic pain described below, with perhaps greater emphasis on the psychosocial dimensions. As with any chronic illness, it is essential to have a robust patient-physician relationship based on patient education, realistic goal, and clarification of mutual expectations.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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