Management of Abdominal Pain

Critical First Step: Exclude Surgical Emergencies

Fever with localized tenderness raises concern for appendicitis, diverticulitis, or abscess, according to the World Journal of Emergency Surgery 1
Abdominal distension with absent bowel sounds suggests bowel obstruction, as noted in Gastroenterology 2

The American College of Radiology recommends specific imaging based on pain location, although the specific details are not provided in the cited reference, it is mentioned in relation to 2

The American Gastroenterological Association recommends starting low-dose tricyclic antidepressant (TCA) as first-line therapy for functional/centrally mediated pain, with options like amitriptyline or nortriptyline 10-25 mg at bedtime, as noted in Gut 4 and Gastroenterology 2
Alternative therapy includes SNRI if TCAs are not tolerated, such as duloxetine 30-60 mg daily for pain modulation, as mentioned in relation to 3
Anticholinergic antispasmodics like dicyclomine are more effective than direct smooth muscle relaxants for IBS pattern with spasmodic pain, according to Gut 4

Cognitive behavioral therapy (CBT) should be initiated early to address catastrophizing and pain-related fear avoidance, as recommended in relation to 3 and supported by Gastroenterology 2

Explaining that pain is real but involves central amplification mechanisms is crucial, using the gut-brain axis framework, as noted in relation to 3

Opioids should not be prescribed for chronic GI pain, as they worsen outcomes and create narcotic bowel syndrome, a recommendation supported in relation to 3