Psychogenic Abdominal Pain - Treatment

The basic principles of treating abdominal pain and other psychogenic disorders of the gastrointestinal tract are uniform and aimed at correcting the mental, vegetative and somatic spheres, taking into account the specifics of each particular syndrome.

Abdominal pain of psychogenic origin requires treatment aimed primarily at correcting mental disorders. Psychotherapy (rational, hypnosis, behavioral therapy, autogenic therapy) is used, focused mainly on the patient's awareness of the connection between their pain and psychogenic factors.

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

Vegetative correction is carried out by conventional means - exposure through breathing exercises and the prescription of vegetotropic agents. Breathing exercises are used according to the described method. It should be emphasized that experimental data indicate a major role of respiratory automatism in the regulation of the motility of the digestive tract, in connection with which the development of respiratory automatism has pathogenetically substantiated indications for the treatment of not only abdominal pain, but also other disorders of the gastrointestinal system.

Abdominal migraine is treated according to the basic rules for treating migraine.

Epileptic genesis of abdominal pain requires the prescription of anticonvulsants depending on the form of epilepsy. The most commonly used combinations are 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 0.15-2 mg/kg) and other drugs can also be used.

If the abdominal pain is caused by hyperventilation or tetanic disorders, the use of mineral correctors and special measures aimed at correcting respiratory disorders are indicated.

Therapeutic efficacy in the treatment of periodic disease is low. The most effective are considered to be drugs of the 4-aminocholine group (plaquenil, delagyl, etc.), antihistamines (histoglobulin, pipolfen, suprastin), drugs that affect the function of deep, including hypothalamic, structures (halidor, reserpine, benzonal). In some patients, paroxysms of pain disappear when changing their place of residence.

Treatment of solar plexus damage consists of identifying the causes of solar syndrome and conducting appropriate etiological and pathogenetic therapy.

In case of "gastric" tabetic crises, drugs containing iodine and bismuth are prescribed according to the instructions. Potassium or sodium iodide is taken orally as a 3% solution, 1 tablespoon 3 times a day after meals. Subsequently, a course of biyoquinol and other drugs are prescribed.

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

In case of abdominal pain of vertebrogenic origin, treatment consists of measures affecting the vertebral and extravertebral (including cerebral) mechanisms of pathogenesis. When the stability of the ligament-articular apparatus is weakened, passive (bed rest, fixing devices) fixation is created and the formation of local myogenic fixation is stimulated (stimulating massage, introduction of biostimulants - vitreous body, aloe, FiBS, rumalon). In the presence of a disc herniation, a neurosurgeon's consultation is necessary. Desensitizing drugs (pipolfen, diphenhydramine, suprastin), non-steroidal anti-inflammatory drugs (ibuprofen, voltaren, butadion, reopyrin, naprosin) are indicated. Novocaine blockades of the involved muscles are effective, leading to a decrease in their tone and a decrease in pain. Special exercises are performed to strengthen the abdominal muscles, manual therapy techniques are used, and acupuncture is indicated.

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

Treatment of irritable bowel syndrome and dyspepsia involves correction of psychovegetative disorders and simultaneous action on possible pathogenetic mechanisms. Antidepressants (most often tricyclic antidepressants) and anxiolytics (diazepine drugs) are prescribed. Antispasmodics are prescribed when pain increases, along with desensitizing agents. A diet with limited consumption of products that promote increased peristalsis is recommended. Laxatives are contraindicated. Psychogenic vomiting requires active psychotherapeutic treatment. The presence of a doctor and the use of techniques that distract from the eating process are of great importance; unloading diet therapy is used, and in the case of persistent vomiting - a starvation diet in combination with intravenous administration of glucose with ascorbic acid, heated alkaline solutions, and phenothiazine drugs taken orally. Attacks of vomiting can be stopped by intramuscular injection of 5 ml of a 5% solution of barbamil and 1-2 ml of a 10% solution of sodium caffeine benzoate. Psychotropic drugs are also indicated.

Treatment of belching and aerophagia consists of normalizing the mental and vegetative spheres. In some persistent cases of aerophagia with hypochondriacal fixation and phobic disorders, long-term psychotherapeutic treatment is required (sometimes with the use of hypnosis, narcohypnosis).

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

The basic principles of treating psychogenic dysphagia are basically the same as in patients with a lump in the throat. A certain therapeutic effect in increasing the tone of the esophagus with dysphagic disorders and chest pain was observed when prescribing calcium blockers, including hydralazine.

Psychogenic congestion 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 with antidepressants and neuroleptics). Normalization of respiratory automatism (see above) plays a major role in regulating the motility and secretion of the digestive system. Vegetotropic drugs should be combined with the prescription of drugs that reduce increased neuromuscular excitability (vitamin D2, calcium and magnesium preparations). Diet therapy and the removal of excessive dietary restrictions, which are found in many patients, are important. It is necessary to eliminate hypokinesia and use a number of yoga exercises aimed at improving the function of the digestive tract.

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