One of the wonderful aspects of physiotherapy is its transversality. There are no approaches specific for a single medical branch, but each individual physiotherapic approach can be applied in many medical branches. For example the treatment of neurogenic disorders, nerve disorders, has its application both in general surgery and in gastroenterology.
Sometimes patients suffer from chronic abdominal pain problems that have no surgical indication, or unfortunately it can happen that the outcome of a surgical operation gives a post-surgical pain that can become chronic; also the consequences of a pregnancy, a natural or cesarean birth.
Nervenia, through studies, research and comparison with anesthesiologists and surgeons, has adapted its approach to neurogenic pain to this type of chronic abdominal pathology.
Chronic abdominal pain is a very frequent and very complex clinical problem, where the diagnosis is often accompanied by numerous inappropriate investigations and by several unsatisfactory treatments, both pharmacological and surgical.
In fact, chronic abdominal pain originating from the structures of the abdominal wall is often mistakenly identified as a visceral pain and treated accordingly, with poor results in terms of relief from pain symptoms. This frequent error of diagnosis determines considerable economic costs. Thompson et al. estimated in 2001 an average cost of $ 6,727 for treatments with no results for each patient who was later diagnosed with chronic abdominal pain. The difficulty is justified by the complex anatomy and pathophysiology of the innervation of the abdominal parietal and visceral components.
The causes can be:
- Post traumatic
- Visceral gastroenterologic pathologies
- Urological problems
- Post surgery
- Vertebral problems
- Nerve problems
- Chronic abdominal pain and nerves
In 1919 Cyriax had already described the existence of apparently visceral pain syndromes, but actually caused by irritation of the intercostal nerves.
It is believed that 10% of patients with abdominal pain visited in gastroenterology departments suffer from chronic abdominal pain or wall pain. The most frequent causes of this syndrome are:
- referred pain starting from an abdominal or, less frequently, thoracic organ,
- radicular lesions of the intercostal nerves,
- lesions of the peritoneum or abdominal muscle wall (especially of nervous origin).
The entrapment of cutaneous nerves seems to be the most frequent cause of abdominal wall pain.
On their way from the dorsal column to the abdomen, these nerves pass through a fibrous ring located in the thickness of the right abdominal muscles, which they can slide freely within. Sometimes these fibers can be stretched and / or irritated by an increase in intra-or extra-abdominal pressure or by a scar or adherence. All these conditions can determine a progressive nerve compression, a real entrapment of the nerves, which can evolve up to ischemia.
A survey of 5,000 patients with chronic abdominal pain showed that in 30% the pain was due to a degenerative pathology, and in 22% it had developed following a surgical procedure. Even interventions such as inguinal hernia or cesarean section can cause chronic post-operative abdominal pain in percentages of 35% and 60% respectively.
The surgical lesion, in fact, acts on the central nervous system and through the inflammatory processes the primary neurons next to the lesion determining the so-called peripheral sensitization, which gives rise to an amplification of the excitability of the secondary neurons, increasing the sensitivity of the area adjacent to the lesion .
The entrapment of the cutaneous nerves of the abdomen has been described as one of the main causes of chronic abdominal pain.
Cures and remedies
Nervenia offers an innovative treatment that can heal or, in the worst case, still clearly improve the situation of chronic abdominal pain.
It is advisable to contact Nervenia in the following cases:
- idiopathic / degenerative chronic abdominal pain;
- search for an alternative to loco-regional anesthesia in pain therapy centers when there are contraindications to this treatment;
- chronic post-surgical abdominal pain in the case of colon-rectal or gastric surgery, caesarean section, cholecystectomy, hysterectomy, inguinal hernia, appendectomy, nephrectomy, kidney or liver transplantation, iliac crest, prostatectomy, laparoscopic surgery in general.
We have included treatment with neuromodulation and deep nerve stimulation (DNS) for chronic abdominal pain in our Nervenia Clinics; we have progressively refined our treatment technique becoming a physiotherapy reference point for these pathologies.