Chronic Severe Abdominal Pain is a Skin Nerve Pain

Lidocaine freezing, administered rectally, can eliminate bowel pains temporarily. Having done that in a case of severe chronic abdominal pains, I found very tender nerve tracts from back to lower abdomen and pelvis on right side, explaining most of the pain.

You can eliminate bowel pains temporarily with rectal lidocaine:

J Pain. 2005 Aug;6(8):493-6.
Intrarectal lidocaine is an effective treatment for abdominal pain associated with diarrhea-predominant irritable bowel syndrome.
Verne GN et al.
http://www.ncbi.nlm.nih.gov/pubmed/16084463

They used 300 mg which would be 6 mls of 5% xylocaine gel rectally

Having done that to a patient with severe chronic abdominal pains, I was hoping for significant pain relief but found she was left with severe nerve tract pains on her right side coming from back and going into lower back and pelvis – I could follow the tender nerve tracts down from back to front.

It was tender all the way to back and associated with paraspinous spasm/tenderness:

Why does the back get involved so much? The psoas muscle does spams when bowel spasms occur:

One sided spasms will twist the spine at the thoracolumbar levels and help initiate pains. s Bowel spasms will refer to skin areas and causing muscle spasms and sensitivity there.

Killing the nerve at T11-12 has been done with benefit to abdominal pains:
New Rx For Chronic Abdominal Pain – Pulse Radiofrequency to Bilateral T10-T11
http://painmuse.org/?p=2904

There is a new treatment for hypersensitive skin nerves called Perineural injection  therapy (previously known as neural prolotherapy). Injecting each cm along nerve with 5% dextrose in water (D5W) – I add 3% glycerine to it – can give relief after repeated weekly treatments.

I manipulate the thoracolumbar joints with an activator device as well.

I have also done nerve blocks to the skin tracts with 5% lidocaine (not too close to spine though)

Comment – Since I have seen it in this lady I have had my eyes opened to fact several other severe abdominal pain cases have skin nerve problems associated with it. If your eyes have been opened too, please let me know!