Chronic Abdominal Pain: An Evidence-Based, Comprehensive Guide to Clinical Management

268 Pages·2015·14.12 MB·English

by  Leonardo Kapural (eds.)

Leonardo Kapural
Editor
Chronic
Abdominal Pain
An Evidence-Based,
Comprehensive Guide to
Clinical Management
123
Chronic Abdominal Pain

Leonardo Kapural

Editor
Chronic Abdominal Pain
An Evidence-Based, Comprehensive
Guide to Clinical Management
Editor
Leonardo Kapural , M.D., Ph.D.
Professor of Anesthesiology
Wake Forest University, School of Medicine
Carolinas Pain Institute and Clinical Research Center
Winston-Salem , NC , USA
ISBN 978-1-4939-1991-8 ISBN 978-1-4939-1992-5 (eBook)
DOI 10.1007/978-1-4939-1992-5
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2014955051
© Springer Science+Business Media New York 2015
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This book is dedicated to my father Mile who was an internist and
cardiologist, but above all, my teacher and inspiration in medicine early in
my life. My mother Zlata, relentless in providing the best for her kids, with a
smile on her face, even through diffi cult times.
My wife Miranda, my lifelong partner in medicine and at home, and my
kids Daniella and Luka who showed incredible patience with me when taking
a large chunk of quality time from them during weekends, evenings, and
holidays in order to complete similar projects.

In Memoriam
James Crews, author of the chapter on regional anesthesia (Chap. 17) who
left us early and unexpectedly before this textbook could be completed. His
work at Wake Forest Regional Anesthesia and Acute Pain Program, his
national and international work in pain medicine, and his presidency of
Carolinas Pain Society will be long remembered

Pref ace
The greatest satisfaction for any physician, when treating a patient with chronic pain, is to
achieve meaningful, and hopefully, long-lasting pain relief. When treating severe chronic
abdominal pain, many obstacles are currently in our way to achieve just that. Those obstacles
include (on occasion) elusive etiology, (frequently) lack of education of referring physicians
on where to refer patient, presence of few long-lasting therapeutic options, and a strong affec-
tive response to the unrelenting pain.
The goal of this textbook was to direct an interested reader to a proper selection of various
therapeutic approaches that currently exist in comprehensive treatment of chronic abdominal
pain. However, in order to provide such information, accumulated knowledge on mechanisms
of pain generation and adaptive mechanisms needed to be detailed fi rst. In addition, various
diagnostic approaches to investigate source of abdominal pain had to be presented.
In this textbook state-of-the-art therapeutic approaches for various causes of chronic
abdominal pain were described by over 60 authors, most of them very busy clinicians, who
invested in translational clinical research, from the bench to innovative therapies. They repre-
sent a wide range of specialties that include pain medicine, psychology, rehabilitation, gyne-
cology, urology, abdominal surgery, neurology, anesthesiology, and neurosurgery.
Still, the core of this textbook is provided by interventional pain physicians. There are sev-
eral reasons for this: a surge in various new minimally invasive approaches in treatment of
abdominal pain that were mastered by this physician group, slow but steady departure from
frequently controversial opioid management of abdominal syndromes, and unrelenting enthu-
siasm by this group to make a difference in treating serious chronic pain. Prolifi c growth of the
Interventional Pain Management Centers and their central role in treatment of other chronic
pain conditions, mainly chronic spinal issues, serves as a good base to tackle prevalent chronic
abdominal pain.
This book, however, is a good reminder that the same problem should be treated by the
multidisciplinary team having knowledge on proposed algorithms for the treatment of such
maladies. A good example in this book is a treatment of chronic pancreatitis. From epidemiol-
ogy, mechanisms, differential diagnosis, innovative new approaches to establish a diagnosis, to
conservative and interventional treatment that includes blocks and radiofrequency ablation, to
more advanced and invasive therapeutic approaches in neuromodulation, abdominal surgery
and neurosurgical approaches were described through 12 different chapters (Chaps. 1 , 2 , 3 , 4 ,
9 , 14 , 15 , 16 , 19 , 22 , 23 , 24 ). In addition, psychological approaches were suggested in the last
(but not least) chapter delivered by Dr. Sweis (Chap. 2 5) . Readers will fi nd such an approach
very informative, however one will notice a lack of described step-by-step algorithm for any of
the pain disorders described. The reason is simple, we are far from providing an accurate algo-
rithm for any condition above, and suggesting an algorithm for various chronic abdominal
problems may be a worthwhile task of the next issue editor. It is just too early for algorithms,
mainly because of a lack of evidence-based literature in this area, and recent advances in the
fi eld without properly assessed risks and benefi ts.
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