Chapter 39

Approach to the Patient with Abdominal Pain

Pankaj J. Pasricha

Pankaj J. Pasricha

Johns Hopkins School of Medicine and Johns Hopkins Carey School of Business, Baltimore, MD, USA

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First published: 27 November 2015

Summary

The gastroenterologist routinely has to deal with abdominal pain as it is one of the commonest symptoms that patients experience. The perception of pain begins in the periphery with the stimulation of certain spinal sensory or afferent neurons (so-called nociceptors); whose cell body lies in the dorsal root ganglion and whose free nerve endings are located between the smooth muscle layers of hollow organs, on their serosal surface, in the mesentery, and within the mucosa of the gastrointestinal tract. Although effective analgesia remains the foremost goal in the pharmacological approach to patients with chronic pain, it must be remembered that there is also a valuable role for drugs in the treatment of concomitant anxiety, depression, and insomnia, a discussion of which can be found in more specialized texts. This chapter provides some general principles to pharmacological approaches of chronic pain.

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