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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!

    06/27/2021 - thought I should add what he had was a “bupivacaine with dexmedetomidine lidocaine abdominal TAP block”. Thursday was pretty rough but he seems to be better each day which is probably why they make you wait 2 weeks to return. We are still very hopeful!

    UPDATE- 06/24/2021 - we went to pain clinic and saw a doctor who comes from Cleveland Clinic twice a week. For the first time since Danny was hurt there is hope for his specific pain relief! According to this doctor he believes based on their exam (and how Danny nearly jumped out of his chair when they touched certain spots) that there is muscle/nerve damage on the top three muscles below right bottom rib. He did three shots on Monday (no local anesthetic necessary) and believes that although this may take several rounds eventually he will be able to heal this area resulting in no pain. The first thought was if the initial injection worked they would do a local and permanently block the nerve but based on his findings during this initial injection he believes that procedure would cause more pain. So here we are - hopeful…I will update accordingly.


    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!
    Last edited by Nickib; 27 Jun 2021, 11:14 AM. Reason: Added type of block and progress for pain relief

    #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.

    Comment


      #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!

      Comment


        #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?

        Comment


          #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.

          Comment


            #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.

              Comment


                #9
                An update for Nickib:

                My daughter had her colonoscopy/endoscopy today. Nothing of note was found. Sooooo, the doctor thinks her pain is related to bowel motility so we are going to work on moving things along better. We already do program daily so no real change there but she is going to take small frequent meals, add more fiber, more activity, and whatever else she needs to do. Motility seems to be the problem because the prep completely cleaned her out and she said she feels great for the first time in quite awhile! No stomach cramps!

                Comment


                • Nickib
                  Nickib commented
                  Editing a comment
                  Wow - isn’t that something? I pray it’s that “simple” of a resolution! Mom always said if you have a “bellyache” that is the cure. Maybe she was on to something. Thanks for the update. Hoping our experiences may one day help someone else. 🙏🏻

                #10
                Originally posted by Domosoyo View Post
                An update for Nickib:

                We already do program daily so no real change there but she is going to take small frequent meals, add more fiber, more activity, and whatever else she needs to do. Motility seems to be the problem because the prep completely cleaned her out and she said she feels great for the first time in quite awhile! No stomach cramps!
                This does not surprise me. I suffer a lot of abdominal pain and I'm quite aware it results from poor intestinal function. After a thorough empty my spasticity goes way down, to a very tolerable level. When there is a lot of waste, especially in the large intestine, I can barely walk for the muscle tension in my abdomen, and sometimes that tension puts my left leg in a torque, or twisting pressure, and the knee and ankle both change position causing those joints to ache. I already eat small meals, but there are many foods that create a lot of gas and that, too, hurts like crazy.

                I would describe my problems as intestinal disorders, including low motility, that trigger strong responses of neuropathy.


                Comment


                  #11
                  Effective bowel program-emptied bowel in less than one hour with aid /enemeez or suppository. Look at consistency of stool. Try to keep what we call a Bristol Stool Score of 4- like a Milky Way-formed, a little soft, no cracks, lumps or bumps. Stool softeners advised and higher dose can be prescribed if needed. Diet of course and water intake. Appendicitis is in RLQ.( right lower quadrant and of course ovaries in both sides. lLQ-constipation, diverticulosis/diverticulitis -caused by chronic consult Opatija but Dr. Can see during colonoscopy. CWO
                  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.

                  Comment


                    #12
                    Good info. We use Enemeez daily. Will watch stool consistency.
                    She is taking oxybutynin, baclofen, and tizanidine. We just read all three cause motility. Might try weaning off the spasm meds with changes to her diet as well and adding docusate. The spasm meds were added because her spasms were so strong (due to this motility problem) so hopefully we'll be able to find the right combo and get her off the spasm meds.

                    Comment


                      #13
                      No just drink more water and if stool dry/hard use stool softeners. Oxybutynin prevents the fluid in the bowel. The motility cause is the SCI. Do not change meds if she is controlled for bladder or spasms. CWO
                      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.

                      Comment


                      • Domosoyo
                        Domosoyo commented
                        Editing a comment
                        Yes, I highly doubt we would drop the oxybutynin based on her urology testing. We're eyeing the baclofen and tizanidine because she has been taking both just a few months. We meet with gastro next week and physiatrist in two. She won't make changes until she sees the dr s. She has already made some diet changes and is drinking even more water and eating lots of watermelon.

                      #14
                      I have a POH in the right hip and I suffer of neuropathic pain, concentrated in the right low abdomen.
                      T4 AIS A since 07/05/2017

                      "We lie the best when we lie to ourselves."

                      Comment


                        #15
                        Cymbals and Effexor are also used for neuropathic pain. De Ers spasms can cause the worse pain. I like Tizanidine ( Zanaflex ) for that. I also prescribe the ointment generic-same as Voltaren. You need to follow the guide. It is quite a lot to rub in but can put an edge on it. Naproxen or Ibuprofen can help also along with stretching. CWO
                        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.

                        Comment

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