STOMACH PAIN

Stomach pain is very common. Throughout this article, the terms stomach pain, abdomen pain and abdominal pain are interchangeable.

Stomach or abdominal pain is felt anywhere below the ribs and above the pelvis but can frequently coexist with pelvic pain. This can be lower, upper, left or right abdominal pain. We discuss pelvic pain separately here.

Major organs located in the abdomen include the stomach and intestines (small bowel and large bowel), appendix, liver, gall bladder, spleen, kidneys and pancreas. Large blood vessels are also found in the abdomen, which include the largest artery (aorta) and vein (inferior vena cava).

Serious causes of stomach pain do exist and might include appendicitis and bowel obstruction, but most stomach pain is mild and goes away without the need for surgery.

Stomach pain can cause disability and sick days from work. It affects men and women, young or old. It can be mild or debilitating. It can start suddenly or slowly. It can be felt it in a small area of the abdomen or over a wide area. It can last days or years. If it becomes chronic it can sometimes be hard to treat and should be treated by pain specialists.

Stomach pain is often short term or acute, and lasts a few hours or days. It usually improves on its own. This is called subacute stomach pain if it lasts between 4 and 12 weeks.

Chronic stomach pain, on the other hand, lasts for 3 months or longer, even after the initial injury or underlying cause of pain has been treated. Chronic stomach pain can persist in people that get acute stomach pain. This means the pain can continue for much longer than expected and in some of those cases chronic stomach pain can be difficult to treat.

STOMACH PAIN SYMPTOMS

Abdominal pain can be cramp-like, dull, achy, sharp, burning or twisting. People can use many different words to describe stomach pain. The pain can be brief and intermittent and come in waves or it can be constant. There might also be tingling, pins and needles and even some weakness. Sometimes there might be nausea and or vomiting or even problems with bladder and bowel function.

Stomach pain is usually felt in the centre of the stomach but can spread or radiate anywhere including around into the back, up into the chest and down into the pelvis.

Sometimes stomach pain occurs suddenly or it can occur slowly. Stomach pain can also occur immediately after an injury or the onset of symptoms can be slow and delayed.

Sometimes people can be very unwell if there is a more serious cause like an appendicitis or bowel obstruction.

• More common and milder causes of stomach pain might include constipation, vomiting, diarrhoea, gastroenteritis, vomiting and stress. Another common cause of stomach pain is acid reflux, which causes heartburn.

• More serious causes of stomach pains might be appendicitis, causes of bowel obstruction or rupture like hernias or trauma. Other serious causes of abdominal pain might include kidney pain and kidney stones or infection, gall bladder pain from gallstones or life-threatening problems with the large blood vessels like an abdominal aortic aneurysm (dangerous swelling of the aorta).

• Cardiac disease can also cause stomach pain. These might include angina or cardiac failure or even a heart attack (myocardial infarction).

• Other serious conditions might include pancreatitis, hepatitis, gastro-oesophageal reflux disease (GORD) and inflammatory bowel conditions like Crohn’s disease or ulcerative colitis or irritable bowel syndrome (IBS). The stomach pain of these conditions can persist and cause chronic stomach pain.

Some causes of chronic stomach pain:

• Many causes of acute stomach pain or bowel pain can result in chronic abdominal pain. Some of the more common causes of chronic stomach pain and intestinal pain include chronic pancreatitis, chronic gastritis, chronic cholecystitis, and functional abdominal pain syndromes.

• Myofascial pain: this is pain that occurs because of problems with the muscles of the abdominal wall like the rectus muscles or oblique muscles. These muscles may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) muscle and can be very painful and quite debilitating. When a trigger point in the abdominal wall is touched or examined, it can cause extreme pain in and around that region. Sometimes problems with the muscles of the abdominal wall can be missed and can cause serious pain and disability. Other muscles that may contribute to stomach pain include the psoas muscle.

• Referred pain: referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the spine and brain. Spine problems like facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerves). This compression condition is called foraminal stenosis and can cause radiating pain anywhere. If the foraminal stenosis occurs at the spinal levels between T6 and T12 the pain that can be felt can occur in the stomach region and can be misdiagnosed as some forms of stomach pain. Spondylosis (osteoarthritis) is spine arthritis, which is an age-related condition that affects the joints, discs and ligaments of the spine. Sometimes spinal pain can cause referred stomach pain and can also be misdiagnosed as various types of stomach pain. Pneumonia can refer pain down into the stomach. Other problems that can refer pain into the stomach might include reproductive organ diseases like ovarian cysts, fibroids, endometriosis or pelvic inflammatory diseases.

• Nerve pain: sometimes neurological problems can cause stomach pain. Neurological causes might include shingles (zoster), post herpetic neuralgia. When pain persists following acute pain, this can sometimes cause changes within the nerves and set up some forms of nerve pain, also called neuropathic pain. Nerve pain can sometimes be hard to diagnose and usually needs to be treated by pain specialists.

• Sensitisation: sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain seems to be spreading up into the body and or down into the arm, or even into the other side of the body. People with sensitisation can even have sensitive skin in the stomach region and even light touch using a brush can be exquisitely painful.

• Post-surgical pain: after an operation or surgery pain can sometimes persist even after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes persistent stomach pain can be intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, and can be caused by many things, including nerve injury or scarring, ongoing inflammation or infection, muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons. Examples of surgeries that can cause persistent post-surgical pain include – inguinal hernia repair, gall bladder removal, or almost any other abdominal surgery, whether they are performed using keyhole techniques (laparoscopic surgeries) or open procedures (laparotomies). In fact, any abdominal surgery can cause chronic stomach pain under some circumstances.

Contact us to find out what's causing your pain.

WHO GETS STOMACH PAIN?

Anyone can get acute stomach pain and it can occur at any age. 

Some people are more likely to develop chronic stomach pain. Here are a few risk factors that might make the development of chronic stomach pain more likely:

• People with chronic pain in other parts of the body like chronic back pain and irritable bowel syndrome (IBS)

• People with a history of anxiety or depression

• Lack of exercise, low fitness level and fatigue

• Females are more likely to develop chronic stomach pain although it does occur in males

WHAT STOMACH PAIN TREATMENT IS AVAILABLE? 

Treatment of the stomach pain depends on if the problem is acute (meaning it only occurred recently i.e. days and weeks) or if the problem is chronic (meaning it has been present for more than 2-3 months).

ACUTE STOMACH PAIN TREATMENT

• Simple treatments like rest or pain medications like anti-inflammatories, anti-spasm and even antacid medications may provide pain relief.

If pain is long lasting (chronic pain), debilitating and has not been responding to treatments an assessement should be made by a pain management specialist, who can assess and treat most types of chronic pain.

• Medications to reduce the pain. These may be simple over-the-counter medications or can be medications prescribed by your pain specialist. Medications might include muscle or anti-neuropathic (nerve pain) medications. Sometimes analgesic compound creams are used to ease pain.

• Pain interventions: injection therapies can be used to target, diagnose and manage chronic pain caused by muscle and nerve pain. It includes interventional therapies like trigger point injections, nerve blocks (transversus abdominus plane (TAP) blocks, ilioinguinal, iliohypogastric or genitofemoral nerve blocks, nerve roots and other abdominal nerves like the subcostal nerves and anterolateral branches of the intercostal nerves) radiofrequency ablation (RFA), pulsed radiofrequency (PRF) and epidural and nerve root steroid injections. Sympathetic nerve blocks can also be performed on the splanchnic plexus, coeliac plexus or hypogastric plexus.

• Some of these therapies can be focused on various structures that might be causing or making the pain worse like the spine facet joints, the spinal nerve roots and other nerves around the spine. Botox injections can be considered for certain types of nerve pain. It is usually injected under the skin of painful areas and can be helpful in providing pain reduction that can last many months at a time.

• Nerve stimulation or neuromodulation techniques: advanced pain reduction strategies may include spinal cord stimulation for severe stomach pain. Some forms of spinal cord stimulation are high frequency stimulation (HF10), tonic stimulation, multi-waveform stimulation, Burst DR stimulation and even dorsal root ganglion (DRG) stimulation.

• Surgery is generally recommended when tests show structural changes that need corrective surgery. This is not a common treatment for chronic stomach pain. Types of surgery might include revision surgery, laparoscopy, laparotomy or surgery on one more organs within the abdomen. They type of surgery required depends on the potential cause of pain.

• Rehabilitation: most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.

WARNING SIGNS OF MORE SERIOUS STOMACH PROBLEMS

In some instances, pain can indicate more serious abdominal problems. These problems might include appendicitis, cancer, infection, bowel obstruction, hernias, and inflammation like hepatitis.

Seek urgent and specialist medical advice if you have:

• Sudden, unrelenting, disabling and severe stomach pain

• Pain lasting for several hours or longer

• Recent injury or fall

• Pain and vomiting or shortness of breath

• Pain and vomiting blood (haematemesis)

• Blood in bowel motions or urine

• Pain that is spreading to the chest, neck or shoulder

• Pain and/or vaginal bleeding with pregnancy

• Pain in the scrotum

• Signs of infection are present like fever and sweats

• Problems with bladder or bowel function like being unable to pass urine or move bowels or pass gas

• Weakness in arms and or legs

• A yellow discolouration of the skin or eyes

• Any other concerns like feeling unwell in any way.