Evaluation and Management of Bilateral Upper Abdominal Sensitivity Nerve Pain

Initial Assessment

The American Gastroenterological Association recommends assessing the relationship to meals or bowel function to suggest functional GI disorder, and presence of other GI symptoms to suggest IBS 1

Basic laboratory tests such as complete blood count, liver function tests, and inflammatory markers should be performed to rule out organic causes, according to the American Gastroenterological Association 3
The American Gastroenterological Association suggests considering imaging studies based on clinical suspicion and symptom pattern 3
Irritable bowel syndrome with abdominal pain as predominant symptom should be considered, as recommended by the European Society of Gastrointestinal and Abdominal Radiology 1

The American College of Gastroenterology recommends tricyclic antidepressants as first-line treatment for neuropathic components, starting with low dose and titrating slowly as needed 1, 4
The American College of Gastroenterology suggests providing careful explanation about mechanism as gut-brain neuromodulator when using tricyclic antidepressants 4
Topical NSAID preparations may be considered for localized pain, as recommended by the National Comprehensive Cancer Network 5
Selective serotonin reuptake inhibitors may be used as second-line therapy if tricyclic antidepressants are not tolerated, according to the American College of Gastroenterology 1
Serotonin-norepinephrine reuptake inhibitors may be used for more severe symptoms, as recommended by the American Gastroenterological Association 2
Antispasmodics may be used for pain exacerbated by meals, according to the American Gastroenterological Association 3

Psychological therapies such as cognitive behavioral therapy should be considered if symptoms persist despite 12 months of drug treatment, as recommended by the American Psychological Association 4
Gut-directed hypnotherapy may be used for visceral hypersensitivity, according to the American Gastroenterological Association 2

The American Gastroenterological Association recommends avoiding repeated and costly investigations once functional diagnosis is established, and being aware that chronic pain may involve central sensitization mechanisms 2
The American College of Gastroenterology suggests setting expectations early that pain perception can be real but multifactorial, and monitoring for hypervigilance to pain 2
The American Gastroenterological Association recommends monitoring for narcotic bowel syndrome due to overuse of opioids 4
The American College of Gastroenterology suggests not dismissing pain as "functional" without appropriate evaluation and targeted treatment 2