Chicago Health | Homepage
Unexplained abdominal pain could be a pinched nerve

Unexplained abdominal pain could be a pinched nerve

The Medicine Cabinet: Ask the Harvard Experts 

By Howard LeWine, M.D.

Q: I have been struggling with a persistent pain on the right side of my belly. Sometimes it feels like it moves from the back to the front and back again. My doctor first ordered blood tests and an abdominal ultrasound. Most recently I had a CT scan of my belly. All normal! My doctor now thinks it might be a pinched nerve. Can a pinched nerve cause this much pain?

A: What you describe is actually quite common. Yes, it does sound like your pain is coming from an irritated nerve leaving the spine. These spinal nerves wrap around from the center of your back to the sides of your body. Doctors call this type of nerve pain radiculopathy, or spinal nerve root pain.

Indeed, the pain can be very severe. Both the patient and the doctor often get concerned that the pain could be related to an intra-abdominal problem. So, it’s not surprising that you had the blood tests, ultrasound and CT scan.

Treating persistent nerve pain can be frustrating. Nerve pain often has a very irritating quality that can be more uncomfortable than pain due to other causes.

There is no single best approach. Finding the right therapies and medications to control persistent pain is a process of trial and error. The goal is to find the most effective combination with the least amount of side effects, while trying to keep costs reasonable.

I often suggest a combination of a nonsteroidal anti-inflammatory drug (NSAID) and one of the tricyclic antidepressants. These are available as inexpensive generics. If you cannot take NSAIDs because of an allergy, kidney problems, gastritis, or peptic ulcer disease, acetaminophen can also be combined with a tricyclic.

Of the NSAIDs, naproxen tends to be my first choice for chronic pain because you only need to take it twice per day. Ibuprofen is just as effective. And if one doesn’t work, try the other.

When I prescribe a tricyclic antidepressant for pain, patients often respond, “But I am not depressed.” Today, tricyclics are used more for treatment of chronic pain, especially persistent nerve pain. Examples include amitriptyline, nortriptyline, desipramine, and doxepin.

I recommend starting with a very low dose, such as 10 milligrams of amitriptyline at night. These drugs can be very sedating; increase the dose gradually. Unlike NSAIDs and acetaminophen, you won’t get the pain relief right away from the tricyclic. It may take a few weeks to work.

There are many other medications available to help relieve nerve pain, including agents applied directly to the skin. Be patient. It may take you and your doctor a while to find a good strategy to ease your symptoms.

(Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor of medicine at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

(c) 2016 PRESIDENT AND FELLOWS OF HARVARD COLLEGE. ALL RIGHTS RESERVED. DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.

Similar Articles

Make your diet more nutrient-dense

Make your diet more nutrient-dense

Environmental Nutrition By Matthew Kadey, M.S., R.D., Environmental Nutrition Newsletter There is only so much food you

Gluten related symptoms: Celiac disease or gluten sensitivity?

Gluten related symptoms: Celiac disease or gluten sensitivity?

The Medicine Cabinet: Ask the Harvard Experts By Howard LeWine, M.D. Q: I seem to be very

Start treatment now to prevent spring allergy symptoms

Start treatment now to prevent spring allergy symptoms

The Medicine Cabinet: Ask the Harvard Experts By Howard LeWine, M.D. Q: I have spring allergies. Every

Does your doctor’s gender matter?

Does your doctor’s gender matter?

By Robert H. Shmerling, M.D. Harvard Health Blog I've read medical research studies that surprised me. I've

10 tips to fight osteoporosis

10 tips to fight osteoporosis

Environmental Nutrition By Carrie Dennett, M.P.H., R.D.N., Environmental Nutrition Newsletter Because 70 percent of our bone destiny

Articles By Category

Family Health

In The Know

CH Lifestyle

May 2017
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
April 30, 2017 May 1, 2017 May 2, 2017 May 3, 2017 May 4, 2017 May 5, 2017 May 6, 2017
May 7, 2017 May 8, 2017 May 9, 2017 May 10, 2017 May 11, 2017 May 12, 2017 May 13, 2017
May 14, 2017 May 15, 2017 May 16, 2017 May 17, 2017 May 18, 2017 May 19, 2017 May 20, 2017
May 21, 2017 May 22, 2017 May 23, 2017 May 24, 2017 May 25, 2017 May 26, 2017 May 27, 2017
May 28, 2017 May 29, 2017 May 30, 2017 May 31, 2017 June 1, 2017 June 2, 2017 June 3, 2017

Categories

Recent Comments

Fund a Cure Night | The Griffith Family Foundation

Fund a Cure Night | The Griffith Family Foundation

Enjoy a great night of baseball at Peoples Natural

VIEW ARTICLE
Swing for the fences in the fight to Sideline Pancreatic Cancer

Swing for the fences in the fight to Sideline Pancreatic Cancer

Enjoy a great night of baseball at Peoples Natural

VIEW ARTICLE

Archives