Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Severe Gastric Pain
Question: My son has been in pain for the last 5-7 years. You can see his aorta thumping and he is in constant pain 24/7. He has had upper GI's, Colonoscopies, Gall Bladder Removed, CAT scans, MRI, contrast die tests, checked for E. Pylori. At this point they simply write it off as gastritis. He is on Vicodin for the pain and as a result I'm pretty sure he has become addicted. In fact, the medicine does not do more than make the pain tolerable. There have been many times when the pain is so bad that he vomits up to 18 hours. He also takes Omeprazole daily. He is 40 years old and cannot work or even socialize. Because there is no definitive diagnosis he is not even eligible for Social Security Disability. He is homebound most of the time unless he has a doctor's appointment. At this time he is no longer being taken seriously by his doctors . They actually act abrasively to his desperate please to be diagnosed. He has insurance thru our state which pays minimally for services so this might be part of the issue, even though it shouldn't be. Any way if I could somehow afford it I would take him to the Mayo Clinic or the XXXXXXX Clinic but I am retired and it's just not in the budget. Any advice for further testing would be most appreciated. This mother is beyond herself watching her son have no life at all. Thanks for listening.
Brief Answer:
I would suggest a few alternative options to investigate.
Detailed Answer:
Hello XXXX!
Thank you for asking on HCM!
I passed carefully through your prescription, and I am sorry to her your son is suffering that way. Seems that every possible tests has been performed and nothing important has resulted from that. Major neurological organic disorders are excluded by MRI, CT scan, etc. Also thoracic and abdominal possible involvements as well by corresponding examinations. At this point, probably we have to look at some very fine level disorders, impossible to investigate by the performed tests.
(1) I would suggest to make some efforts to rule out what is called thoracic neuropathy and small fiber disease that may be responsible for the above clinical scenario. In such case an ENG test is necessary.
(2) Another entity to look for is fibromyalgia, a disorder at the central nervous system neurotransmitters level, responsible for the chronic pain syndrome. In such case some examinations like single-voxel magnetic resonance spectroscopy, voxel-based morphometry, positron emission tomography, may identify specific affected brain areas and the corresponding responsible neurotransmitters dysfunctions.
Regarding treatment, antidepressant therapy, like duloxetine, as well as drugs like gabapentin or pregabalin would be helpful to reduce symptoms.
Nevertheless, to confirm or rule out such disorders, I would highly recommend to consult a neurologist expert in the field, to guide the differential diagnosis, as well as treatment and follow up.
Hope to have been helpful. Feel free to ask me whenever you need.
Greetings! Dr. Iliri
I would suggest a few alternative options to investigate.
Detailed Answer:
Hello XXXX!
Thank you for asking on HCM!
I passed carefully through your prescription, and I am sorry to her your son is suffering that way. Seems that every possible tests has been performed and nothing important has resulted from that. Major neurological organic disorders are excluded by MRI, CT scan, etc. Also thoracic and abdominal possible involvements as well by corresponding examinations. At this point, probably we have to look at some very fine level disorders, impossible to investigate by the performed tests.
(1) I would suggest to make some efforts to rule out what is called thoracic neuropathy and small fiber disease that may be responsible for the above clinical scenario. In such case an ENG test is necessary.
(2) Another entity to look for is fibromyalgia, a disorder at the central nervous system neurotransmitters level, responsible for the chronic pain syndrome. In such case some examinations like single-voxel magnetic resonance spectroscopy, voxel-based morphometry, positron emission tomography, may identify specific affected brain areas and the corresponding responsible neurotransmitters dysfunctions.
Regarding treatment, antidepressant therapy, like duloxetine, as well as drugs like gabapentin or pregabalin would be helpful to reduce symptoms.
Nevertheless, to confirm or rule out such disorders, I would highly recommend to consult a neurologist expert in the field, to guide the differential diagnosis, as well as treatment and follow up.
Hope to have been helpful. Feel free to ask me whenever you need.
Greetings! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
