Approach to the Patient with Abdominal Pain
Pankaj J. Pasricha
Johns Hopkins School of Medicine and Johns Hopkins Carey School of Business, Baltimore, MD, USA
Search for more papers by this authorPankaj J. Pasricha
Johns Hopkins School of Medicine and Johns Hopkins Carey School of Business, Baltimore, MD, USA
Search for more papers by this authorDaniel K. Podolsky MD
President, University of Texas Southwestern Medical Center, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorMichael Camilleri MD
Executive Dean for Development, Atherton and Winifred W. Bean Professor, Professor of Medicine, Physiology and Pharmacology, Distinguished Investigator, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJ. Gregory Fitz MD FAASLD
Executive Vice President for Academic Aff airs and Provost, University of Texas Southwestern Medical Center, Dean, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorAnthony N. Kalloo MD
Professor of Medicine, Johns Hopkins University School of Medicine, Director, Division of Gastroenterology & Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
Search for more papers by this authorFergus Shanahan MD
Professor and Chair, Department of Medicine, Director, Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland
Search for more papers by this authorTimothy C. Wang MD
Chief, Division of Digestive and Liver Diseases, Silberberg Professor of Medicine, Department of Medicine and Irving Cancer Research Center, Columbia University Medical Center, New York, NY, USA
Search for more papers by this authorSummary
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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