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Unexplained belly pain? Consider nerve irritation

Unexplained belly pain? Consider nerve irritation

The Medicine Cabinet: Ask the Harvard Experts

By Howard LeWine, M.D.

Q: I have had persistent pain on the right side of my belly for six months. I had blood tests, a CT scan and an ultrasound. Everything came up normal. My doctor thinks the pain may be due to an irritated nerve. Is this common? What’s the treatment?

A: An irritated nerve as the cause of unexplained pain on one side of the body is more common than appreciated.

People with this condition often describe the pain as burning, sharp, tingling or stinging. It may feel like the pain radiates around the side from front to back or back to front. The skin in the area of the pain can be very sensitive or sometimes feel a bit numb.

The exact reason for the nerve irritation may not be determined. It could occur from an outbreak of shingles (herpes zoster) without a rash or a slightly pinched nerve as it exits from the spine. There are other less common causes.

Doctors call the pain due to nerve irritation neuropathic pain. The usual pain medications like acetaminophen, ibuprofen and naproxen may help a little. But drugs that damp down inappropriate or excessive pain signaling in the nerves tend to be much more effective.

The two classes of drugs that doctors prescribe most often for nerve pain were originally developed to control seizures (anticonvulsants) and to treat depression (antidepressants).

In addition to dampening nerve activity in the brain to prevent seizures, anticonvulsants also help to blunt pain signals in the nerves. Several are in wide use for chronic pain. The most commonly used one is gabapentin (Neurontin), but there are others, including carbamazepine (Tegretol), lamotrigine (Lamictal) and pregabalin (Lyrica).

It takes four to six weeks for the full effect to kick in. Your doctor will start you on a low dose and gradually increase it. That reduces side effects.

Certain types of antidepressants also help to control nerve pain. They may have a synergistic effect in people who experience depression along with chronic pain: chronic pain often causes depression, and depression can intensify a person’s sensitivity to pain; some antidepressants address both.

Tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan) and nortriptyline (Pamelor), have the strongest evidence backing them. They are often very effective at low to moderate doses to help reduce side effects.

Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor), tend to have fewer side effects, but may not be as effective as the tricyclics.

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

(c) 2017 PRESIDENT AND FELLOWS OF HARVARD COLLEGE. ALL RIGHTS RESERVED. DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.

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