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Undifferentiated abdominal pain
FRANK LOVECCHIO AND STEPHEN H. THOMAS
n Agents
n Opioids
n NSAIDs
n Evidence
This chapter is intended to address one of the broadest topics in acute care
pain management: abdominal pain of uncertain etiology. Although some
patients present to the ED with known diagnoses (e.g. recurrent kidney
stone), the acute care provider is usually in a position in which analgesia
decisions must be made in the setting of diagnostic imprecision. In truth,
diagnostic certainty after an initial ED evalaution is often elusive. There will
always be need for some degree of judgment as to appropriate analgesia,
given patients’ conditions, levels of pain, and relative likelihood of varying
diagnoses (e.g. leaking aortic aneurysm versus renal colic). With that caveat,
the reader is referred to other chapters of this text for cases in which the cause
of abdominal pain is known. This chapter’s discussion is intended to serve
two functions. First, the chapter is intended to address treatment for patients
where the cause of pain is unclear. Second, the chapter is intended to provide
general guidance for treatment of abdominal (including pelvic) pain, serving
as a reference for conditions (e.g. salpingitis, bowel obstruction) lacking
sufficient analgesia data to warrant a separate chapter.
Perhaps the most important, and certainly the most historically controversial,
issue with respect to treatment of undifferentiated abdominal pain
(UAP) is whether any analgesia should be given. Based on physical examination
concerns that have inertia from nearly a century of clinical application,
some authors still write that relief of pain can dangerously obfuscate
the diagnostic process. 1 Those concerns are mentioned here for the express
purpose of categorically disagreeing with the practice of withholding analgesia