GI Pain and Dx Algorithms Flashcards
Which types of pain are responsive to analgesics/ severity of pain directly proportional to severity of disease?
YES: inflammatory pain, pain as a symptom
NO: neuropathic pain (nervous system is changed, severity of pain is related to the severity of neural system change), pain as a disease (chronic pancreatitis), inflammatory mediators can sensitize pain
What factors can work to cause visceral sensitization to pain?
abnormal inputs like repetitive stimulation
acute inflammation as in the setting of infection
neurological trauma due to operations or invasive procedures
What are different causes of chronic pain of the gut?
visceral hypersensitivity
central hypersensitive
(or both)
What is deafferentation?
chronic pain create changes in the dorsal horn, thalamus and cortex, produces a ‘hard wired’ pain pattern so that non-noxious stimuli or different organs can induce previously established pain pattern
What is the role of silent nociceptors in visceral pain?
silent nociceptors in the gut that normally convey moment develop peripheral sensitization when inflamed and convey pain
viscera and pain have bilateral and sparse innervation so pain is felt in the midline and as vague sensation
What might you observe in a patient with colic pain (body language/ position)
intermittent paroxysms of cresendo/decresecendo and intensity based on size of the lumen cause patients to be restless or to assume the fetal position
each lumen having a characteristic cycle and severity
Give examples of injury that could cause parietal pain.
skin damage
muscle/insertion
adhesion or inflammation of parietal peritoneum
Where might pain from the gallbladder, pancreas or arts be referred to?
gallbladder –> right scapula
pancreas –> mid back
aorta –> inner thigh, scrotum, labia
What organ system illness in the chest may cause referred pain to the gut?
MI, pneumonia and pulmonary embolus
What symptoms may be associate with abdominal pain?
nausea, vomiting, diarrhea, constipation and anorexia (less commonly insomnia, anxiety, depression and loss of coping)
What is the role of psychological stress in abdominal pain?
early life trauma linked to visceral hypersensitivity
life stress can modify the pain perception of IBD, mood disorders are linked to persistent pain in quiescent IBD
depression and anxiety in adult and pediatric IBD (mechanism unknown)
What is the role of education for abdominal pain to address psychological aspects of abdominal pain?
goal of education is to help patients appreciate the connection between pain and psychological triggers as well as as factors that may exacerbate the pain (social reinforcement and school/work)
may also focus on maladaptive behaviors, increase tolerance of symptoms and encourage independent coping skills
How is CBT used to treat abdominal pain?
CBT is used to alter behavior, perception and thinking to change mood and sensations, interrupt automatic emotional processing (responsible for maintaining negative conniptions) and teaches problem-solving skills, often stress management
What are the advantages of psychological treatment?
high response rate (70% approx)
can benefit those not responding to medical treatments; and can be additive or synergistic such treatments
reduces healthcare costs and benefits can last after treatment ends
