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Severe pain in the stomach. Normal GI ultrasound. Taking Lyrica. Chances of Abdominal Cutaneous Nerve Entrapment Syndrome?

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Internal Medicine Specialist
Practicing since : 1998
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On 10/4 I started to have intense pain in the upper left quadrant of my stomach. It was the same day my mother had the Whipple Procedure done for pancreatic cancer and the stress and anxiety was brutal. It would wax and wain but it felt like 'stabbing' or 'burning'. I had an abdominal ultrasound and an upper GI...both were fine. I was wondering if this could possibly be Abdominal Cutaneous Nerve Entrapment Syndrome? The pain feels like it is on the surface and currently is intense. I am trying Lyrica but my personal feeling is I need an anesthetic. Any ideas or avenues to explore?
Posted Sat, 28 Apr 2012 in Abdominal Pain
 
 
Answered by Dr. Jasvinder Singh 1 hour later
Hello,

Thanks for posting your query.

I can understand your concern for these symptoms but before labeling this burning and intense pain as Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES), it is better to rule out other medical causes like gastritis which may also be triggered by anxiety and stress and any pancreatic cause. We always make a point to look out for pancreatic cause when a patient reports with pain on left side under rib pain. Pancreatitis should always be ruled out in such cases.

It is good that your ultrasound and upper Gastro intestinal endoscopy has come out normal. I suggest you to consult a physician and get serum lipase and serum amylase done to rule out any pancreatic cause.

Till that time, you can apply warm compresses on the area and take some anti inflammatory pain killer after consulting your doctor.

Local anesthesia is the treatment for ACNES but it is to be given only when all other causes for such pain are ruled out.

Also avoid alcohol or drinks with caffeine in them, chocolate or spicy or greasy foods and instead take cold foods preferably liquids like milk and yoghurt. It also might help to avoid eating or drinking for two hours before you lie down. You may also need antacids and proton pump inhibitor drugs for controlling the stomach acid.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Please accept my answer in case you have no follow up query.

Wish you good health.

Regards
Above answer was peer-reviewed by
 
Follow-up: Severe pain in the stomach. Normal GI ultrasound. Taking Lyrica. Chances of Abdominal Cutaneous Nerve Entrapment Syndrome? 41 hours later
Thank you Dr XXXXXXX I should have mentioned I have had two blood tests done that have ruled out pancreatic catalysts for this pain. It is right below my left rib cage. I have a bit of a rash under my left armpit and was thinking perhaps shingles but would pain travel to the area I am experiencing it? It is very strange. I also was wondering your opinion of acupuncture for nerve type pain. Thanks again and my best.

XXXXXXX
 
 
Answered by Dr. Jasvinder Singh 20 hours later
Hello,

Thanks for writing back to me.

Shingles presents with a tingling feeling, itchiness, or stabbing pain on the skin. After a few days, a rash appears as a band or patch of raised dots on the side of the trunk which develops into small, fluid-filled blisters.

Keep an eye on the skin and if there is appearance of any bumps, then shingles should be ruled out.

If the pain is caused by any nerve compression, then you may benefit by acupuncture but if it is caused by gastritis then it is unlikely to be relieved by acupuncture.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Please accept my answer in case you have no follow up query.

Wish you good health.

Regards
Above answer was peer-reviewed by
 
Follow-up: Severe pain in the stomach. Normal GI ultrasound. Taking Lyrica. Chances of Abdominal Cutaneous Nerve Entrapment Syndrome? 4 hours later
Thanks again and last one:) Wouldn't the gastritis have shown on the upper GI......can that flare? The day I had the procedure this was feeling ok...just not sure. Thanks for your time. Best.
 
 
Answered by Dr. Jasvinder Singh 13 hours later
Hello,

Thanks for writing back.

Often gastritis is a diagnosis based on the patient's symptoms. But sometimes blood tests that look for Helicobacter pylori like antibodies to H.pylori can be done. A positive result warrants a strict management of gastritis with anti H pylori drugs.

Endoscopy checks for stomach lining to look for inflammation and mucous erosion; but if you had endoscopy before any inflammation of stomach lining can occur then there is every possibility that it may have been missed.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Please accept my answer in case you have no follow up query.

Wish you good health.

Regards
Above answer was peer-reviewed by
 
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