filmov
tv
Chronic Abdominal Pain | Cincinnati Children's
Показать описание
Ken Goldschneider, MD, Director, Pain Management Center:
Hi, Dr. Goldschneider from the Pain Management Center at Cincinnati Children's hospital.
We're going to talk about chronic abdominal pain, which affects a whole lot of children and young adults and can be very, very severe. But, one thing about it is it can be very, very frustrating. Because so many people just end up hearing very simple names being given to what bothers them so very much.
Things like functional abdominal pain, or recurrent abdominal pain or IBS, which stands for irritable bowel syndrome. Nifty little names that don't really explain anything about what's going on.
So, what is going on?
Well, I'm going to show you two pictures today in the course of this presentation. Let's look at the first one. Now in this first one, you can see that there is an awful lot that goes on between the brain and the GI tract. All right, so with all of the stomach and the intestines and all that, there can be inflammation, infections and all sorts of things that go on. There's all sorts of stuff that has to function properly in the spinal cord and all the pathways that go up and down between the brain and GI tract. And then, all has to be well within the brain. So, there are a number of things that can affect how pain is processed.
And as you may remember from seeing the video on anxiety, there are all sorts of things that go on at the level of the brain.
So, let's take a look at a factor that we see very, very frequently as sort of a trigger of the abdominal pain. Now, this is inflammation. Inflammation can be from something like an infection, such as a GI bug where the whole family has been in the bathroom for a few days. And then, like three months later, this young person has pain as if they're still sick. It could be Crohn's disease or ulcerative colitis where they've had a flareup for a while. And then, even though the scopes are all looking good, there's still pain. It can be from the eosinophilic disorders. It can be from pancreatitis, a whole bunch of things.
What they all have in common is that there are changes with inflammation and the interaction between the lining of the GI tract and the nerves that go to it. And the result of those changes is that certain chemicals, the messengers between cells, change. So, now there's an increase in sensitivity in the nerves. And now those upgoing pathways I showed you that drawing of, become much stronger because that pain is constantly going along them. And like a muscle, the more it gets used, the stronger it gets.
And more related to the other video on emotional and anxiety processing, that downgoing pathway sometimes gets a little weak. So, that imbalance causes a big, big problem.
But it's that inflammation that very, very frequently gets things started.
But there's even more to it than that. That's complicated enough. Let's take a look at the second graphic. Now, the first thing you're going to say when you look at this is, 'Woah. This is an awful lot.'
Don't worry, you don't have to know everything about this. I'm not even going to talk about all of it. The point is, if you look over on the right, the word "IBS" goes up. That simple little term people throw around. Well, that's the end result. That's what you get when you walk into the doctor's office and they give you a bunch of tests and stuff and come up with a conclusion.
But, the big point here is look at all of the stuff to the left of it. All of those four columns worth of things that could go on in varying amounts to combine together to end up with that very simple-sounding label.
So, as you can see, those simple-sounding names can be very frustrating because they don't really explain anything. But, underneath them, there is a lot that goes on. And I hope you can appreciate that now. Fortunately, with all of that, there are a number of things that can go on to balance those pathways and decrease the pain sensitivity and decrease the pain processing. nd end up helping people feel a whole lot better with a lot less pain.
So, I hope that's helpful. And I will see you next time. This is Dr. Ken Goldschneider, signing off.