Psychogenic abdominal pain: treatment

The basic principles of treatment of abdominal pain and other psychogenic disorders of the gastrointestinal tract are unified and aimed at correcting the mental, autonomic and somatic areas, taking into account the specificity of each specific syndrome.

Pain in the abdomen of psychogenic nature requires treatment, aimed primarily at correcting mental disorders. Psychotherapy (rational, hypnosis, behavioral therapy, autologous therapy) is applied, focused mainly on the patients' awareness of the connection of their pains with psychogenic factors.

The choice of psychotropic drugs is determined by the structure of the syndrome of mental disorders. In the case of the detection of a mental illness, counseling and treatment are indicated by the psychiatrist.

Vegetative correction is carried out by usual means - exposure through respiratory gymnastics and the appointment of vegetotrophic agents. Respiratory gymnastics is used according to the described technique. It should be emphasized that experimental data testify to the great role of respiratory automatism in the regulation of gastrointestinal motility, in connection with which the development of respiratory automatism has pathogenetically substantiated indications for the treatment of not only abdominal pains, but also other violations of the gastrointestinal system.

Abdominal migraines are treated according to the basic rules of migraine treatment.

Epileptic genesis of abdominal pain requires the appointment of anticonvulsants depending on the form of epilepsy. The most commonly used combinations of the basic drug phenobarbital (1-5 mg / kg 1-2 times) with carbamazepines - finlepsin, tegretol (7-15 mg / kg 2 3 times). Clonazepam (antelepsin 0.1-0.2 mg / kg), benzodiazepines (seduxen at 0.15-2 mg / kg) and other drugs can also be used.

If the basis of abdominal pain is hyperventilation or tetanic disorder, the purpose of mineral correctors and special measures aimed at correcting respiratory disorders are indicated.

Therapeutic efficacy in the treatment of recurrent disease is low. The most effective drugs are group 4-amincholine (plakvenil, delagil, etc.), antihistamines (histoglobulin, pifolen, suprastin), drugs that affect the function of deep, including hypothalamic, structures (halidor, reserpine, benzonale). In some patients paroxysms of pain disappear when the place of residence changes.

Treatment of the defeat of the solar plexus is to identify the causes of solar syndrome and conduct appropriate etiological and pathogenetic therapy.

When "gastric" tabetic crises prescribed drugs containing iodine and bismuth, according to the instructions. Iodide potassium or sodium is taken orally in the form of a 3% solution of 1 tablespoon 3 times a day after meals. In the subsequent appoint a course of biyohinola and other drugs.

In the treatment of porphyria, it is possible to prevent the occurrence of acute episodes of abdominal pain and neuropathy, without prescribing the drugs that cause them. When clinical symptoms appear for the relief of pain and correction of hypochondriacal disorders, aminazine can be used. Intravenous administration of glucose reduces the excretion of porphyrin precursors with urine; In addition, intravenous administration of levulose and hematin is indicated.

In the case of abdominal pain vertebrogenic nature of treatment consists in carrying out activities that affect vertebral and extravertebral (including cerebral) mechanisms of pathogenesis. With the weakening of the stability of the ligaments and joints, passive (resting, fixing devices) is fixed and the formation of local myogenic fixation is stimulated (stimulating massage, introduction of biostimulants - vitreous, aloe, fibs, rumalon). If there is a disc herniation, a neurosurgeon should be consulted. The preparations of desensitizing action (pifolen, dimedrol, suprastin), non-steroidal anti-inflammatory drugs (ibuprofen, voltaren, butadione, rheopyrine, naprosin) are shown. Novocaine blockades of the involved muscles are effective, leading to a decrease in their tone and a decrease in pain. Carry out special exercises aimed at strengthening the abdominal muscles, apply techniques of manual therapy, it is shown acupuncture.

Abdominal pain in other organic neurological diseases (multiple sclerosis, syringomyelia, tumors) is closely related to the dynamics of the underlying disease, and their treatment depends on the therapy of the corresponding disease.

Treatment of irritable bowel syndrome and dyspepsia consists in the correction of psycho-vegetative disorders and simultaneous action on possible pathogenetic mechanisms. Assign antidepressants (most often tricyclic antidepressants) and anxiolytics (diazepine drugs). Spasmolytics is prescribed with increased pain along with desensitizing agents. A diet with a restriction of products that promote peristalsis is recommended. Contraindicated laxatives. Psychogenic vomiting requires active psychotherapeutic treatment. Of great importance are the presence of the doctor and the use of diversions from the process of eating; use unloading diet therapy, and in case of persistent vomiting - a hunger diet in combination with intravenous injection of glucose with ascorbic acid, heated alkaline solutions, preparations of the phenothiazine series inside. Vomiting attacks can be stopped by intramuscular injection of 5 ml of a 5% solution of barbamyl and 1-2 ml of a 10% solution of caffeine-benzoate sodium. The drugs of the psychotropic series are also shown.

Treatment of belching and aerophagy is the normalization of the mental and vegetative spheres. In some persistent cases, aerophagy with hypochondriacal fixation and phobic disorders requires long-term psychotherapeutic treatment (sometimes with the use of hypnosis, drug hypnosis).

When treating "coma in the throat" it is necessary to take into account the multidimensionality and multifactority of pathogenetic mechanisms. Correction of mental (emotional) disorders is carried out by psychotherapeutic influence (behavioral, family therapy, hypnosis) and the appointment of psychotropic drugs (tricyclic antidepressants, anxiolytics, neuroleptics). There is a distinct effect in the appointment, in particular, alprozalam (1 tablet 3-4 times a day for several months). Vegetative correction includes the appointment of vegetative means (anaprilin, obzidan, belloid, bellason, pyrroxane). The presence of signs of increased neuromuscular excitability requires the appointment of mineral correctors (vitamin T> 2, calcium preparations). An important point of treatment is the elimination of signs of respiratory dysfunction and hyperventilation syndrome.

The basic principles of treatment of psychogenic dysphagia are basically the same as in patients with coma in the throat. A definite therapeutic effect with an increase in the tone of the esophagus with dysphagic disorders and chest pain was observed with the appointment of calcium blockers, including hydralazine.

Psychogenic zalor and diarrhea require persistent complex treatment. Psychotherapy should be aimed at correcting the internal picture of the disease, reducing hypochondriacal fixation and phobic disorders. Long-term psychotropic therapy is required (most often antidepressants and neuroleptics). A major role in the regulation of motor function and the secretion of the digestive system is the normalization of respiratory automatism (see above). Wegetotropic drugs should be combined with the appointment of drugs that reduce the increased neuromuscular excitability (vitamin D2, calcium, magnesium preparations). Importance of diet therapy and the removal of excessive nutritional restrictions that occur in many patients are important. It is necessary to eliminate hypokinesia, apply a series of exercises on the yoga system, aimed at improving the function of the digestive tract.

[1], [2], [3], [4], [5], [6]