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Right lower Abdominal Pain - Something has got to give here!

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    Right lower Abdominal Pain - Something has got to give here!

    My husband Danny will be 21 years paraplegic in September. He has chronic pain toward the front lower right abdominal area - ALL THE TIME. Usually is is "manageable" and he does not need to take his Vicodin, which he uses VERY sparingly. Lately this pain will not let up! No, he does not have a UTI. He has had a really rough 2021 with an ischeal pressure sore that now has a wound vac, had issues with the Foley catheter and DID have UTIs which have been resolved. We have tried injections, CBC oil and cream and even medical marijuana but nothing, and I mean nothing kicks this, not even the Vicodin some days. Every specialist he asks, SCI, urologist, PCP, you name it, just says they have no idea. Surely there is SOMEWHERE or SOMEONE we can see that can help figure this out! Early on in his paralysis he was told it was his gallbladder, so they removed it. His pain started in the recovery room! We are near Pittsburgh, PA, but honestly would travel almost anywhere if we knew something would help. He used to only have a few days a month where the pain was nearly unbearable, causing him to take up to 6 Vicodin in a 24-hour period, but lately it just will NOT let up, at all. Thank you for any advice!

    #2
    I assume he has had an ultrasound or CT of the area in question to rule out something like a tumor or abscess?

    Some people with SCI have visceral (organ) neuropathic pain, and if any actually pathology in the area has been ruled out, it may be treated as with any neuropathic pain. Opioids actually are not very good drugs for neuropathic pain. Generally Neurontin, Lyrica, or Tegretol are the first line drugs for neuropathic pain. Have these been tried?

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      Originally posted by SCI-Nurse View Post
      I assume he has had an ultrasound or CT of the area in question to rule out something like a tumor or abscess?

      Some people with SCI have visceral (organ) neuropathic pain, and if any actually pathology in the area has been ruled out, it may be treated as with any neuropathic pain. Opioids actually are not very good drugs for neuropathic pain. Generally Neurontin, Lyrica, or Tegretol are the first line drugs for neuropathic pain. Have these been tried?

      (KLD)
      Yes, he has had multiple ultrasounds and CTs which were all clear. He had a routine neurogenic bladder battery of testing in March also. He has been on as much as Neurontin (tried 900 mg twice a day max) daily which just made him sleep. Lyrica did not touch the pain. I do not believe he has been on Tegretol. I am curious, given that the other two suggestions did nothing, is Tegretol worth a try?

      Here is a summary (from his running medication list) of some of what he has been tried on . . . Topamax, Licocaine/Prilocain cream (from compound pharmacist), Baclofen, Cyclobenzaprine, Lyrica, Zanaflex, Skelaxin, Neurontin. All of these are discontinued.

      As a side note, the urolgogist just restarted Ditropan (5.0 mg once a day) to help relax his bladder since his suprapubic cather was implanted last Wednesday. Many years ago he was trying to go from the condom catheter to the straight-cath method and she put him Ditropan but he was constantly having accidents so that - and the straight-cath method were discontinued.

      I always appreciate your input SCI Nurse! Thanks!

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        #4
        We've been trying to pinpoint my daughter's lower ab pain too, so some of what you wrote is very familiar. We ruled out quite a bit and are down to gastroenterology and gynocology. She met with gastro last Friday and he seems to think IBS. I thought she had some kind of ulcer or hernia but her high anxiety seems to be a contributing factor to IBS so maybe that is the problem. Her spasms are the strongest they've ever been. (She is on meds for the spasms and trying use her stander more.)

        Does Danny have spasms too along with the pain?

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          #5
          Thank you for your reply. Yes Danny has spasms as well. In fact sometimes his pain in that area is so intense it’s like a spasm and he will literally grab his side and squeeze to help alleviate it. I’m sorry to hear that your daughter is having these issues also. I thought Danny was on something for IBS at one point but I’m not sure. Please keep us posted as to how your daughter is doing and what helps.

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            #6
            Last night she had pain and if she moved at all big spasms. She takes small doses of Baclofen and trizanidin before bed but it doesn't seem to do much. It will be awhile before her testing starts. Those appointments are in mid-June. I will send an update for sure!

            Comment


            • swh2007
              swh2007 commented
              Editing a comment
              I have had these pains for years, particularly at night. I have come to the conclusion that they relate to bowel disruptions. In my case (per gastro doc), apparently my colon is very long with sharp bends, which apparently causes IBS type symptoms, which I think cause the spasms that trigger the intense pain. In addition to normal bowel management, lactose intolerant pills (lactaid) and tums etc before bed seem to help. Rolling over in bed also helps.

            #7
            Hmmm....interesting. For years I’ve suggested that perhaps these pains ARE related to having to have a BM. Seems though that doesn’t seem to correlate. Some days these intense pains start morning till night and beyond and sometimes later in the day is when it is really bad. I wonder if a lactate regimen (daily? morning?) would help Danny? Thank you for the information. I figure he is not the only person suffering from this and perhaps someone - or many - will have a solution that may work for him!

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              #8
              If I sit up for too long without moving around, ensuring proper blood flow to my internal lower organs, I'll begin sweating before the pain kicks in. I'm not saying this is the same issue, just sharing what causes my lower pain in that area.

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