Severe Gastric Pain and Flank Discomfort
My partner, who is 48 years old, has been grappling with episodes of severe abdominal discomfort, along with pain in both sides of his body, for over two decades. The onset of these episodes coincided with the removal of his gallbladder, during which they discovered the presence of sludge. Despite the surgery, the discomfort persisted for a couple of years before it gradually improved on its own for some time. However, the pain returned sporadically, showing patterns of distress that alternated between periods of intensity and relief. Initially, he was very frustrated with the medical professionals who treated him, leading him to seek help again only in 2015. Unfortunately, he was dismissed with an ambiguous diagnosis of irritable bowel syndrome (IBS), even though his symptoms do not align with typical bowel movement issues, which caused him to stop pursuing further medical opinions. Since October 2023, he has entered a particularly acute phase of his pain, which has progressively worsened without any indication of alleviation. After much persuasion, I encouraged him to undergo a thorough evaluation, and we have pursued every diagnostic avenue available, including CT scans, ultrasounds, capsule endoscopy, and even tests for porphyria. Sadly, the results have come back unremarkable. The neurology department recently declined a consultation requested by his pain management specialist, stating they do not handle cases of abdominal pain, despite my partner occasionally experiencing dizziness and nystagmus during severe flare-ups. At present, his pain levels are severe, rating a troubling 9 out of 10. We have explored a wide range of medications, yet none have provided relief. We learned that he cannot metabolize many common medications processed by the CYP3A4 enzyme pathway, which limits our options significantly. While morphine, which bypasses this pathway, has hardly made an impact, neither have gabapentin or other typical treatments. For months, he has been unable to experience relief below a 4 on the pain scale. This situation is profoundly affecting his quality of life, and it breaks my heart to witness his suffering. Any thoughts on potential explanations? Are there even rare conditions that could relate? He often describes the pain in haunting terms, likening it to "frostbite" or as if "something is burrowing through him."
Answers (1)
3/26/2025, 8:50:42 PM
OpenHealth AI
I'm truly sorry to hear about your partner's ongoing struggles with severe abdominal pain and related symptoms. It's understandable how frustrating and distressing this situation must be for both of you. There are several points to consider, given the complexity of his symptoms and history, and I'll provide some potential avenues for exploration moving forward.
Main Points:
- Persistent abdominal pain after gallbladder removal can be due to various factors, including post-cholecystectomy syndrome.
- It's crucial to address the lack of medication efficacy given his unique metabolic challenges.
- Consider exploring additional diagnostic avenues, particularly concerning nerve-related issues or rare conditions.
Explanation:
First, given your partner's history with gallbladder removal and persistent pain, it's possible he may be experiencing post-cholecystectomy syndrome. This syndrome can manifest as abdominal pain, indigestion, and other gastrointestinal symptoms after gallbladder surgery. The pain can stem from gallbladder sludge or residual bile duct issues, though imaging has not shown these problems in his case.
His pain description—“haunting” and “like frostbite”—indicates a potentially neuropathic component to his pain, especially considering the dizziness and nystagmus you've observed. This could suggest involvement of the nervous system, which may not have been thoroughly evaluated given the refusal by the neurology department.
Next Steps:
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Consult Gastroenterology Again: Find a gastroenterologist who specializes in functional gastrointestinal disorders. This may open doors to further evaluations focused on his symptoms beyond typical IBS. Ask about treatments specifically for nerve-related pain or potential conditions like Sphincter of Oddi Dysfunction.
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Pain Specialist Reevaluation: Since traditional pain management strategies have been ineffective, seek out a pain management clinic that specializes in complex pain syndromes. They might suggest alternative approaches such as nerve blocks, biofeedback therapy, or other therapies focused on pain modulation that could address neuropathic pain.
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Symptom Diary: Keep a detailed log of his symptoms, triggers, pain intensity, dietary factors, and any other contextual details. This is invaluable for healthcare providers in better understanding his condition and could clarify patterns that would inform treatment decisions.
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Investigate Rare Conditions: Although rare, conditions such as visceral hypersensitivity or other neurological conditions might need to be explored. Discuss with his healthcare team the possibility of additional assessments that might reveal less common causes of his symptoms.
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Multidisciplinary Approach: Consider integrating alternative therapies such as acupuncture, physical therapy, or cognitive behavioral therapy (CBT), which can offer supportive relief and coping strategies for managing chronic pain.
Conclusion:
While your partner’s pain is undoubtedly distressing, continuing to pursue comprehensive evaluations and potential interdisciplinary approaches is vital in seeking relief. Monitor his symptoms closely, and ensure he feels supported throughout this journey. Your advocacy for him is critical, and together you can explore further avenues for improvement.
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