Abdominal Pain: Is It All in the Belly?
Tuesday, 9:45-10:45 a.m.
Upper 20B-C

Abnormal physiology, not anatomy, may be the cause of chronic abdominal pain, a condition known as functional abdominal pain that needs to be treated with patient education in the form of “mental rehabilitation,” not with medication.

“Sometimes people are in pain not because there is ongoing tissue damage, but because their pain-processing pathways are not working well,” said Tariq M. Malik, M.D., who will present “Abdominal Pain: Is It All in the Belly?” from 9:45 to 10:45 a.m. tomorrow in Upper 20B-C.

“I explain to the patient that the bowel is moving all the time, maybe for digestion. But such sensation doesn’t leave your conscious level, so you do not feel the bowel moving all the time,” said Dr. Malik, Assistant Professor of Anesthesiology and Critical Care at the University of Chicago. “Patients start feeling a pain sensation when the filtering mechanism breaks down or sensory input from the bowel is altered. In general, no anatomical damage exists, but new physiology results in pain. That is what is happening, and medication does not solve the problem.”

Too often, patients in chronic pain — and their physicians — have a desire to diagnose a problem or label it, leading to inaccurate diagnoses and overuse of pain medications, he said. The better option is to treat the condition as functional abdominal pain.

“We, as a medical community, should not give a diagnosis if we do not have an exact diagnosis. Sometimes, medication or intervention is not always the right thing,” Dr. Malik said. “Quite often, it is best to just step back and educate the patient. Quite often, the way we feel chronic pain is that the whole brain function is getting worked up. Education is telling people they should realize we don’t have an exact pain center in the brain. Pain is more like an emotional state. When people have a chronic pain condition, quite often it is a disease, it is not a symptom.”

Before reaching that conclusion, though, a multispeciality approach should be used to investigate all options and eliminate any anatomic issues, such as tumors or infections, as the cause of pain, he said.

“At that point, you tell the patient you best manage this with good patient education and developing ‘mental rehab.’ When I tell people I am sending them to a pain psychologist, I stress that this is not a mental condition; it is like when you need rehab after surgery, so you go to a physical therapist,” Dr. Malik said. “The pain psychologist is like a coach to help you develop the brain power to contact the pain centers of the brain that are not working well, and that will help you. We need to stop intervening and start educating patients early.”