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Suggest Treatment For Dull Pain In Upper Left Abdomen
Question: I have had a dull pain in my left upper abdomen for 8 years. Started within 2 months of a complicated gallbladder removal. Nothing shows on ultrasound, CT Scan, colonoscopy, etc. Only hurts while standing or walking. No pain while lying down. Also I have progressive MS that affects left side. Dr. Suggested possible pain mgt. injecting into abdominal wall. HELP!
Brief Answer:
cannot say in your particular case
Detailed Answer:
Certainly residual inflammation, deformity, blockage of the gallbladder, liver or pancreas can be assessed with simple blood tests. The pain would not generally be positional. Scarring/adhesions would. In general adhesions are a dumb idea to try to fix because that involves further surgery and produces further adhesions. HOWEVER, if the adhesion is unusual enough, it will NOT reform when cut. Cannot say in your particular case except it is not the usual situation (complicated). I do not know what they would be injecting. .. injection of a nerve toxin to kill any pain nerve in the area might be used?
An alternative cause of very localized pain is an irritation of a very small nerve. Very small amounts of a nerve pill OR lidocaine patches externally can be helpful in this case (amitryptiline, cymbalta, gabapentin, pregabalin are most of the commmonly used nerve pills).
cannot say in your particular case
Detailed Answer:
Certainly residual inflammation, deformity, blockage of the gallbladder, liver or pancreas can be assessed with simple blood tests. The pain would not generally be positional. Scarring/adhesions would. In general adhesions are a dumb idea to try to fix because that involves further surgery and produces further adhesions. HOWEVER, if the adhesion is unusual enough, it will NOT reform when cut. Cannot say in your particular case except it is not the usual situation (complicated). I do not know what they would be injecting. .. injection of a nerve toxin to kill any pain nerve in the area might be used?
An alternative cause of very localized pain is an irritation of a very small nerve. Very small amounts of a nerve pill OR lidocaine patches externally can be helpful in this case (amitryptiline, cymbalta, gabapentin, pregabalin are most of the commmonly used nerve pills).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, Dr. Wachsman, for answering me so quickly. The pain mgmt. doctor did notify my regular doctor yesterday that he didn't see how an ultrasound guided injection into the abdominal wall would help me. I guess at this point I'm at a loss. There are times when my left upper abdomen feels hard as a rock and almost feels like its bulging. No amount of Ibuprofen or acetaminophen helps. The hyoscyamine ER 4 x per day partially takes the edge off. The pain is much worse later in the day when I've been on my feet. My Dr. asked what I would like to try next. It has been several years since my last CT scan or ultrasound. Would it show adhesions/scar tissue? I would like to try the lidocaine patch if you think that would be of benefit. Is that by prescription or OTC? Just recently was diagnosed with Type 2 diabetes (A1c 7.2, trying to control with Metformin, diet and exercise). Add that to the MS and severe psoriasis (controlled by Humira) and I think I've had enough! Thank you, I value your opinion.
Brief Answer:
Scar tissues is not bone
Detailed Answer:
so x ray modalities are not very likely to show it. Ultrasound is incredibly operator dependent and about zero risk of pain, damage, or radiation, so even if it is unlikely to work, it is hard to be against it. MRI is an interesting choice.......it shows different densities of stuff (fat, water, air, bone) and might show something and again, no damage/radiation.
And, of course, there are the nerve pills......
Then, there is the question of mobilizing scar tissue. Deep tissue massage is painful and perhaps slightly dangerous and in theory, mobilizes scar tissue.
http://physicaltherapy.about.com/od/typesofphysicaltherapy/a/Scar-Tissue-Massage-And-Management.htm
I guarantee you will feel better afterwards (it will be painful; you will be very glad when it stops). And, it might offer long term help.
Scar tissues is not bone
Detailed Answer:
so x ray modalities are not very likely to show it. Ultrasound is incredibly operator dependent and about zero risk of pain, damage, or radiation, so even if it is unlikely to work, it is hard to be against it. MRI is an interesting choice.......it shows different densities of stuff (fat, water, air, bone) and might show something and again, no damage/radiation.
And, of course, there are the nerve pills......
Then, there is the question of mobilizing scar tissue. Deep tissue massage is painful and perhaps slightly dangerous and in theory, mobilizes scar tissue.
http://physicaltherapy.about.com/od/typesofphysicaltherapy/a/Scar-Tissue-Massage-And-Management.htm
I guarantee you will feel better afterwards (it will be painful; you will be very glad when it stops). And, it might offer long term help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes, I have had MRIs as late as Oct. 2015 for my MS, which showed nothing. I already take amitriptyline as a sleep aid. I will talk to my doctor about the deep tissue massage and the lidocaine patches. Thank you for your help!
Brief Answer:
You are quite welcome
Detailed Answer:
a few summary statements:
MRIs have to be of the relevant area. There are two or three. It is UNLIKELY that the head is involved if moving the abdomen causes a problem. BUt problems in the local nervous system (the nerves in the area and their spinal connections) can be involved and an MRI probably would show involvement of MS if it were there. MRI of the abdomen would be needed to see an adominal problem (scar) not seeing it does not rule it out as scars are often small and not very noticeable.
Lidocaine patch is by prescription. Except for irritation from the adhesive, side effects are close to impossible because the lidocaine goes locally and is metabolized by the liver in seconds.
Amitryptiline is probably the best but is not the only nerve pill out there.
You are quite welcome
Detailed Answer:
a few summary statements:
MRIs have to be of the relevant area. There are two or three. It is UNLIKELY that the head is involved if moving the abdomen causes a problem. BUt problems in the local nervous system (the nerves in the area and their spinal connections) can be involved and an MRI probably would show involvement of MS if it were there. MRI of the abdomen would be needed to see an adominal problem (scar) not seeing it does not rule it out as scars are often small and not very noticeable.
Lidocaine patch is by prescription. Except for irritation from the adhesive, side effects are close to impossible because the lidocaine goes locally and is metabolized by the liver in seconds.
Amitryptiline is probably the best but is not the only nerve pill out there.
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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