Successful Management of Persistent Abdominal Pain in a 70-Year-Old Patient

Background:

A 70-year-old male presented with persistent abdominal pain of sudden onset. The pain was described as a constant, sharp sensation with intermittent episodes of electric shock-like pain. The discomfort occasionally radiated to the upper part of his hips and was exacerbated by prolonged sitting, driving, standing, and walking short distances. Over the past few weeks, the intensity of the pain had rendered the patient housebound. Although the pain was somewhat alleviated by lying down, turning in bed exacerbated it, leading to disturbed sleep. The patient denied any associated back pain, sensory disturbances, or bowel and bladder dysfunction.

Past Medical History:

The patient had no significant history except hypertension. He was pretty active before the onset of this pain.

Medications:

The patient tried various medications including paracetamol, codeine, amitriptyline and tramadol without benefit.

Investigations:

MRI scan of the spine ordered by a spine specialist revealed a disc protrusion at the T12/L1 level extending behind the body of T12 without cord compression. This finding was unchanged compared to a previous scan from 2019. The spine specialist recommended a review from Dr Krishna, Consultant in Pain, at Pain Spa.

Initial Treatment and Outcome:

The patient consulted Dr. Krishna at Pain Spa for pain management. Due to the severity and persistence of symptoms, the patient was offered interventional treatment and underwent bilateral transforaminal epidural injections at the L1 level under fluoroscopy guidance as a day-case procedure. The injections resulted in significant pain relief, with the patient reporting a 75% improvement in symptoms. Functional abilities markedly improved, allowing the patient to engage in daily activities more effectively. Sleep disturbances were also significantly reduced.

Despite the improvement, the patient continued to experience residual pain over the anterior abdominal wall at the level of the umbilicus, which occasionally disrupted his sleep.

Further Management:

To address the persistent anterior abdominal wall pain, Dr. Krishna recommended bilateral abdominal cutaneous nerve blocks under ultrasound guidance. This procedure aimed to be both diagnostic and therapeutic. Following the nerve block, the patient experienced 100% pain relief. This result not only confirmed the source of the residual pain but also provided a complete resolution of symptoms.

Follow-Up and Outcomes:

Post-treatment, the patient reported being pain-free, with significant improvements in mobility and functionality. He resumed normal activities and even booked two holidays, highlighting the profound impact of the treatment on his quality of life.

Discussion:

This case illustrates the importance of a multimodal and targeted approach to managing persistent abdominal pain, particularly in the absence of back pain or significant neurological findings. The combination of fluoroscopy-guided transforaminal epidural injections and ultrasound-guided abdominal cutaneous nerve blocks proved highly effective in achieving pain relief and restoring function. Dr. Krishna’s expertise in interventional pain management and the use of advanced imaging techniques were instrumental in delivering these excellent outcomes.

Conclusion:

This case underscores the efficacy of interventional pain management techniques in treating complex pain presentations. The patient’s remarkable recovery highlights the importance of individualized care and the potential for significant improvements in quality of life through precise, minimally invasive treatments.

For more details please visit www.painspa.co.uk.