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Neurology (Expert Forum)
Neuropathic Abdominal Pain
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Neuropathic Abdominal Pain
by ltpainsuf4rrrr, May 31, 2005 12:00AM
14 years ago I was stricken with severe abdominal pain (left side only). 3 years ago, it worsened to unbearable. I'm a 56 year old male, very active and physical in nature until 3 years ago. Pain is located near the surface of my abdomen, feels like not more than 1/2" deep. I was referred to a pain management specialist in August, 2002 after exploratory showed nothing organic. She prescribed Oxycontin for the pain, but I continued to blow through higher and higher levels quickly as my pain progressed. In early 2003, my pain doctor suggested a nerve block, specifically a Celiac Plexus. It was performed using a fluoroscope and I received 6 full weeks of relief from my pain. My doctor performed three more of these blocks during the next four months, but I received little relief. She suggested a fifth Celiac Plexus block using a CT Scan claiming it is more accurate than using a fluoroscope.
I decided to get a second opinion from another pain specialist at a major academic center. While both doctors claim my abdominal pain is caused by a neuropathty origin, the second doctor states I should not have any more blocks because these blocks are typically performed on patients with an organic origin. However, this second doctor also believes my pain syndrome is so severe, that narcotic drugs will most likely have run their course in about five years, thus leaving me in horrible pain at that time and for the rest of my life. I’ve had many studies over the years, including multiple studies of each of CT-Scans (
I decided to get a second opinion from another pain specialist at a major academic center. While both doctors claim my abdominal pain is caused by a neuropathty origin, the second doctor states I should not have any more blocks because these blocks are typically performed on patients with an organic origin. However, this second doctor also believes my pain syndrome is so severe, that narcotic drugs will most likely have run their course in about five years, thus leaving me in horrible pain at that time and for the rest of my life. I’ve had many studies over the years, including multiple studies of each of CT-Scans (
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jun 01, 2005 12:00AM
I'm sorry that they have been unable to find the exact cause of your abdominal pain
Organic basically means that there is underlying structural disease causing the medical problem, Non-organic means that no identifiable strucutral disease can be found or the problem is related to dysfunction of normal structures. Without knowing your diagnosis, pain treatments are at best, a guessing game
One can obtain an idea of the origin of the pain - whether from nerve, spinal, visceral, or soft tissue origin by a careful history, I do not have enough information to ascertain which. Certain medications are more effective for a type of pain, for instance Nerve medications like Neurontin for nerve pain, visceral blocks like celiac blocks for visceral pain (organ pain)
Without a diagnosis of a diseased organ its unclear how a celiac block is working inyour case - usually it is used for abdominal cancer related pain
Have you had automonic function tests to assess abdominal autonomic function ie gastric emptying studies? Has diabetes been ruled out (a common cause of abdominal nerve related pain). Have you been checked for Porphyria (a rare but treatable cause of functional abdominal pain, a simple urine and blood test can tell). Also a herpetic viral infection could cause a similar picture with residual nerve damage. Lyme disease can cause a thoracic radiculopathy but not one that lasts so long, although there could be residual nerve damage. A vasculitis (inflammation of blood vessels) can cause ischemia of the abdomainal organs and chronic pain, I dont know if you have had an abdominal angiogram?
Narcotic drugs are effective in many types of chronic pain and are 'broad-spectrum'. Tolerance does develop over time requiring higher doses to get the same effect. Drug holidays can help avoid this to a certain extent. I cannot predict how they will change in your case over the next few years. Better to find other medication without tolerance and addictive potenital, and more specific for your problem, for instance nerve pain related medications like Neurontin, amitryptaline, Venlafaxine etc, or devices such as a spinal stimulator. Please see you pain management doctor for details or alternatively the Pain Management Center at the Cleveland Clinic over a multimodal pain management service if you would like another opinion. They may also be able to assess for a spinal stimulator if you are suitable for this.
Good luck
Organic basically means that there is underlying structural disease causing the medical problem, Non-organic means that no identifiable strucutral disease can be found or the problem is related to dysfunction of normal structures. Without knowing your diagnosis, pain treatments are at best, a guessing game
One can obtain an idea of the origin of the pain - whether from nerve, spinal, visceral, or soft tissue origin by a careful history, I do not have enough information to ascertain which. Certain medications are more effective for a type of pain, for instance Nerve medications like Neurontin for nerve pain, visceral blocks like celiac blocks for visceral pain (organ pain)
Without a diagnosis of a diseased organ its unclear how a celiac block is working inyour case - usually it is used for abdominal cancer related pain
Have you had automonic function tests to assess abdominal autonomic function ie gastric emptying studies? Has diabetes been ruled out (a common cause of abdominal nerve related pain). Have you been checked for Porphyria (a rare but treatable cause of functional abdominal pain, a simple urine and blood test can tell). Also a herpetic viral infection could cause a similar picture with residual nerve damage. Lyme disease can cause a thoracic radiculopathy but not one that lasts so long, although there could be residual nerve damage. A vasculitis (inflammation of blood vessels) can cause ischemia of the abdomainal organs and chronic pain, I dont know if you have had an abdominal angiogram?
Narcotic drugs are effective in many types of chronic pain and are 'broad-spectrum'. Tolerance does develop over time requiring higher doses to get the same effect. Drug holidays can help avoid this to a certain extent. I cannot predict how they will change in your case over the next few years. Better to find other medication without tolerance and addictive potenital, and more specific for your problem, for instance nerve pain related medications like Neurontin, amitryptaline, Venlafaxine etc, or devices such as a spinal stimulator. Please see you pain management doctor for details or alternatively the Pain Management Center at the Cleveland Clinic over a multimodal pain management service if you would like another opinion. They may also be able to assess for a spinal stimulator if you are suitable for this.
Good luck
My first doctor is at odds with my second doctor, stating my neuropathy problem is unique and since the first Celiac Plexus block was a success (6 weeks no pain, first time in 12 years pain free), I should continue with the blocks. She also says if the second opinion doctor is correct about my narcotics running their course in approx 5 years, he isn’t offering any resolution to my problem and is actually leaving me with a grim prognosis of the future.
I have a severe neuropathy problem, currently being treated with Methadone 25 MG daily and Xanax 1.0 to 1.5 MG daily and I am getting some relief from pain. However, my second opinion doctor has me very worried these medications are going to fail me in the next several years. I
Is it a medically accepted to perform Celiac Plexus blocks on patients who don’t have an organic origin? So far, the first Celiac Plexus block is the only medical treatment that has given me complete relief from pain.
Thanking you in advance for any help you can give to me.