Sunday, April 17, 2022

What is Causing My Stomach Pain?

One of the most vexing issues for patients and their doctors is dealing with unexplained abdominal pain.  Indeed, over the course of my career, I have treated thousands of these patients.  Every day, one or two of them are on my office schedule.

Many of them have had abdominal distress for decades.  Many have had several visits to emergency rooms and have seen multiple gastroenterologists and other doctors over the years.  Diagnostic tests are done and often repeated in the ongoing quest to find an explanation.  When I review a patient’s entire medical record, I am often astonished to learn how many CAT scans have been repeated to evaluate the same pain.

These patients understandably are operating under the notion that the medical profession should be able to explain the cause of their pain. This is the primary reason that these individuals seek care.  This is, after all, the job of a doctor.  In addition, they also want decent pain control so that they can live a more normal life.

Sometimes, it's best to choose another route.

If a patient has chronic and unexplained pain, there are two possibilities.  The first is that the physicians and medical professionals who have evaluated the patient over months and years have missed a lurking diagnosis.  Perhaps, no one considered a rare illness. Or a common condition was the culprit but was behaving in an uncommon manner making it difficult to recognize.  No physician can ever be 100% certain that every conceivable diagnosis had been excluded.  Here are samples of patient inquiries that I am unable to categorically reject.  “Could this be a parasite?”  “Are you sure this couldn’t be cancer?” “My aunt had the same symptoms and it took years until they knew it was her gallbladder.”  While these possibilities may be unlikely, I can never absolutely dismiss them

The second possibility is that the unexplained pain is also unexplainable.  Readers may be surprised to learn that this group of patients is the largest category in our abdominal pain patients.  Most of the abdominal pain we see won’t light up on an imaging study or a lab test.  Many of these patients may be assigned a diagnosis of irritable bowel syndrome, which may include an array of digestive symptoms which are difficult to explain even though a ‘diagnosis’ has been made.

Can folks with unexplainable abdominal pain be helped?  Absolutely.  But for many of them, gastroenterologists may not be the most skilled specialists for these cases, even though we are ‘stomach doctors’.  For example, if a patient sees me for a 3rd or 4th gastro opinion, it is likely that the patient is not on a healing pathway.  If the same approach in medicine, or in life, is failing, then it’s time to change direction.  And this is often the advice I offer these patients.  I tell them that I do not know which particular path they should pursue, but they need to make a left or a right turn rather than continue along on the same road.  They should be open to alternative approaches including functional medicine, integrative medicine, acupuncture, naturopathy, meditation and even hypnotism, among others.  This is not time for physician arrogance.  Many times, I have looked these patients in the eye and pointed out that since the prior strategy has brought no relief that a new approach must be considered.  In nearly every case they immediately get it since it just makes sense.  For many of them, it’s a why didn’t I think of that’ moment. 

When physicians’ and patients’ minds are open, there is much greater chance to find healing and relief. 


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