The Chest (which is sometimes referred to as the Thorax), the Abdomen, and the Pelvis host many vital organs, like the heart, lungs, kidneys, bowels, and bladder. Acute pain in these areas is usually an alarming sign that directs our attention to seek medical care to make sure nothing serious is going on that needs immediate intervention. But how about when all the tests come back negative and the pain is becoming the disease itself, or when there is some underlying disease that is causing a lot of pain that is affecting the quality of life?
Here comes the role of Pain Physicians to evaluate the different sources of pain and suggest possible treatments and therapies. Some of these pain syndromes could be divided into different areas:
Chronic Pain of the Chest:
-Any injury to the ribs could cause a long and lasting pain, e.g. Fracture after a fall, or an injury after surgery (Post-Thoracotomy Syndrome). This can lead to chronic pain in the nerves adjacent to the ribs, a condition called Intercostal Neuralgia. Your physician may suggest interventions like Intercostal nerve block or neuropathic pain medications or sometimes both. In refractory cases, the physician may suggest Spinal Cord Stimulator (SCS) or Peripheral Nerve Stimulator (PNS).
-Another common chronic pain condition that affects especially elderly patients is Shingles (also called Herpes Zoster caused by Varicella Zoster Virus), could linger for many weeks or months after the initial lesions appear and could be very painful. Your physician could recommend a combination of injections, medications or a new topical therapy that uses high doses of Capsaicin applied through patches at the doctor’s office.
Chronic Pain of the Abdomen:
-Not uncommon after certain surgeries, like after hernia repairs, some patients may develop ongoing pain at the incision site, here a specific Ultrasound-Guided Nerve Block could help to relieve the pain, or in refractory cases, a specific type of Spinal Cord Stimulator called DRG (Dorsal Root Ganglion) Stimulator could be recommended by your doctor.
-Some of the Gastrointestinal pathologies like Chronic Pancreatitis, Pancreatic cancer, or other sympathetically mediated syndromes could respond well to targeted sympathetic chain blocks like Celiac Plexus Block or Superior Hypogastric Plexus Block.
Chronic Pain of the Pelvis:
-Chronic Pelvic Pain sometimes could be a very challenging problem that requires the collaboration of multiple specialists like Gynecologists, Gastroenterologists, and Urologists along with pain physicians for proper diagnosis and treatment. Chronic pelvic pain can have multiple causes, it can be a symptom of another disease, or it can be a condition in its own right. If the pain appears to be caused by another medical problem, treating that problem may be enough to eliminate the pain. However, in many cases, it’s not possible to identify a single cause of chronic pelvic pain. In that case, the goal of treatment is to reduce your pain and other symptoms and improve your quality of life. Some of these syndromes are Endometriosis, Interstitial nephritis, Irritable Bowel Syndrome, or Pudendal Neuralgia.
-After proper evaluation and testing your pain doctor may recommend different treatment modalities like physical therapy, psychotherapy, neuropathic pain medications or specific type of injections like image-guided nerve blocks that may include Ganglion of Impar block.
-Luckily there are new treatments and therapies that are emerging to help in managing these challenging syndromes like DRG-Spinal Cord Stimulator and Peripheral Nerve Stimulator. Please discuss with your doctor if you qualify for one of these therapies.