Interventional Pain Management in Chronic Upper Abdominal Pain in Adults

Abstract

Chronic upper abdominal pain management is a challenge for all pain physician, and it is in general classified into functional and organic abdominal pain , in additional to abdominal wall pain. Thoroughly assessed patient with history and examination, and proper workout diagnostic tools, add a help in reaching proper diagnosis. Multimodal treatment strategy which consists of medical treatment staged by simple analgesics to weak opioids and then graded to strong opioids, supported by antispasmodics, laxatives, seretonergic agonists, tricyclic antidepressents, and anticonvulsants. Moreover, cognitive behavioral therapy, acupuncture, and surgery are another different treatment modalities, the last step is interventional pain management, by neurolysis or radiofrequency with different approaches as splanchnic nerve ablation, celiac plexus ablation, cryoablation, differential epidural blockade, paravertebral block, intercostals nerve block, intrathecal opioids and lastly neuromodulation. The future need more researches for less invasive, more safer and curable procedure, in addition to a novel drug as an alternative for invasive procedures.