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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Intermittent Abdominal Pain While All Scan Reports Normal, Prescribed Amitriptyline. Is It Necessary ?

I am a 44 yr old female with abdominal pain. The pain began intermittently about 1 and 1/2 yrs ago. I went to the doctor and they completed an ultrasound of my abdomen and also an EGD. No findings of gallbladder stones, etc. Since that time I have had instances of pain in the same area (upper right side) - sometimes after meals but not consistent until about 5 weeks ago. I went to the urgent care and they ordered a HIDA scan. I did not have the test at that time because morphine used in the test makes me sick. Four weeks later the pain was acute and I went to the ER. They did another abdominal ultrasound - no stones. I did follow-up with my doc who ordered the HIDA scan - had it done and no stones. I also had a CT and another EGD and colonoscopy - no stones but the pain now is every day. I have an appt with a surgeon on Monday only because I have become my own advocate for help - the pain is there and they have dismissed it as gastroenteritis - I have had GERDs for the past 10 yrs and it is much worse now with the pain on the right side. The doc who completed the colonoscopy prescribed a drug for cramping after but also prescribed Amitriptyline??? Let's be clear, I am not depressed. Yes, for the past 2 weeks that they have been trying to diagnosis this pain, it has been rough, but why would they prescribe this drug? It is so frustrating to be in pain daily and then because they cannot seem to figure it out, they think that I must be depressed?? I am hopeful that the surgeon will either order an MRI to more precisely diagnosis what is going on, or take out the gallbladder. Your thoughts?
Thu, 26 Dec 2013
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Internal Medicine Specialist 's  Response
Thanks for coming to Health care Magic.
I understand your concerns of pain with no apparent cause diagnosed and repeated testing is making you frustrated. Doctors sometimes prescribe Amitriptyline for pain and for functional causes. Lets leave that aside and focus on your pain issue.
You have mentioned that you have GERD, what treatment are you taking for that? Also, you indicated the link of pain with meals, can you please tell us more about this pattern (in how much time after meals does pain start, location of start, does the pain radiate/move/spread anywhere, duration it lasts, what makes it better, any link with particular food items). Also, did you notice any link of pain with cough/deep breathing? Does the pain increase on pressing the area or increase after taking-off hand pressure? How is your bowel movement pattern? If you got stool analysis done, please share reports with us.
In upper gastroscopy, how was the mucosa status ? In colonoscopy, did they find any diverticuli? I am asking details of these questions to understand your condition better so that we can help you.
If you have not visited your surgeon yet, I would suggest to wait and avoid any further testing while you share the above details about your pain and test reports. But in case of severe pain, please visit emergency. Gall bladder removal might not solve your problems rightaway and every surgery (open or laproscopic) comes with its side effects; I would recommend avoiding it till the cause is clear.
Hope you get better soon.
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Intermittent Abdominal Pain While All Scan Reports Normal, Prescribed Amitriptyline. Is It Necessary ?

Thanks for coming to Health care Magic. I understand your concerns of pain with no apparent cause diagnosed and repeated testing is making you frustrated. Doctors sometimes prescribe Amitriptyline for pain and for functional causes. Lets leave that aside and focus on your pain issue. You have mentioned that you have GERD, what treatment are you taking for that? Also, you indicated the link of pain with meals, can you please tell us more about this pattern (in how much time after meals does pain start, location of start, does the pain radiate/move/spread anywhere, duration it lasts, what makes it better, any link with particular food items). Also, did you notice any link of pain with cough/deep breathing? Does the pain increase on pressing the area or increase after taking-off hand pressure? How is your bowel movement pattern? If you got stool analysis done, please share reports with us. In upper gastroscopy, how was the mucosa status ? In colonoscopy, did they find any diverticuli? I am asking details of these questions to understand your condition better so that we can help you. If you have not visited your surgeon yet, I would suggest to wait and avoid any further testing while you share the above details about your pain and test reports. But in case of severe pain, please visit emergency. Gall bladder removal might not solve your problems rightaway and every surgery (open or laproscopic) comes with its side effects; I would recommend avoiding it till the cause is clear. Hope you get better soon.