Overview
I saw a 56 year old lady in the Pain Clinic. She was complaining of pain in the umbilicus, moving around in a band. This is usually a niggling pain with a pain score of 4-5/10 but at worst 10/10. This usually occurred once every 3 weeks lasting for 2-3 days.
Symptoms
She has suffered with this continuously for the last couple of years and felt burning internally, as if someone was sticking a knife into her and turning it. She also has some abnormal sensitivity to the skin. She was taking Co-dydramol and Tramadol but felt this was of little help. She had a past medical history of diverticulitis, hiatus hernia, asthma and gall bladder problems.
Examination findings
On examination she had a laparoscopic scar underneath her umbilicus, a gall bladder incision scar and tenderness in the left and right upper quadrant on deep palpation. She had a band of pain running from the umbilicus towards the right flank and around the umbilicus was an area of increased sensitivity to pin prick sensation (hyperalgesia).
Treatment of neuropathic abdominal pain
My impression was that of a lady with neuropathic elements to her pain. She was started on Amitriptyline 15 mg nocte. This dose was slowly escalated to Amitriptyline 30 mg nocte and Tramadol and Gabapentin were also increased. At 3 months she was taking Gabapentin 1000 mg t.d.s., Amitriptyline 30 mg nocte and Tramadol. In her own words, “my husband says I am a changed woman”.
Patient follow-up
At her 6 month review, this lady was on the same medication and I was very pleased to see that overall there was improvement and in her own words, “things have calmed down”. For flare up pain she was using Tramadol as required, which she found quite useful.
