Advertisement

Chronic Pain Due to Postsurgical Intra-abdominal Adhesions: Therapeutic Options

  • Jose De Andres
  • Luciano Perotti
  • Stefano Palmisani
  • Vicente Luis Villanueva Perez
  • Juan Marcos Asensio-Samper
  • Gustavo Fabregat
Chapter

Abstract

Intra-abdominal adhesions are an important source of chronic pelvic pain. Thus, every physician should be familiar with pathogenesis of pain from adhesions, sources of referred pain, and the methods by which they can be prevented and treated.

The tests appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of abdominal pain.

Conventional pharmacologic therapy, sympathetic blocks, and radiofrequency application are important tool for the treatment of chronic visceral pain, but unfortunately they offer only a transient pain relief. Minimally, invasive pain interventions are very useful, but their correct choice must be based in the correct selection of the patients on the basis of the result of tests defining taxonomy of pain.

Central and peripheral neuromodulation (spinal cord stimulation, peripheral nerve stimulation, and peripheral field stimulation) has a role in the treatment of neuropathic pain deriving from nerve entrapment or radiculopathy. Pulsed radiofrequency may provide pain relief in thoracic radicular pain and Intrathecal Drug Delivery is an effective tool to be considered when other therapeutic options fail to provide adequate pain relief.

More basic research into the mechanisms of adhesiogenesis is truly needed for developing useful preventing Strategies

Keywords

Neuromodulation Spinal cord stimulation Peripheral nerve stimulation Peripheral field stimulation Intrathecal drug delivery Pulsed radiofrequency Chronic pain Postsurgical intra-abdominal adhesions Abdominal pain 

References

  1. 1.
    Sulaiman H, Gabella G, Davis C, Mutsaers SE, Boulos P, Laurent GJ, et al. Presence and distribution of sensory nerve fibers in human peritoneal adhesions. Ann Surg. 2001;234:256–61.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Dig Surg. 2001;18:260–73.PubMedCrossRefGoogle Scholar
  3. 3.
    Gebhart GF. Pathobiology of visceral pain: molecular mechanisms and therapeutic implications IV. Visceral afferent contributions to the pathobiology of visceral pain. Am J Physiol Gastrointest Liver Physiol. 2000;278(6):G834–8.PubMedGoogle Scholar
  4. 4.
    Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: a frequently overlooked problem. Am J Gastroenterol. 2002;97:824–30.PubMedGoogle Scholar
  5. 5.
    Lindsetmo R, Stulberg J. Chronic abdominal wall pain—a diagnostic challenge for the surgeon. Am J Surg. 2009;198:129–34.PubMedCrossRefGoogle Scholar
  6. 6.
    Gallegos NC, Hobsley M. Abdominal wall pain: an alternative diagnosis. Br J Surg. 1990;77:1167–70.PubMedCrossRefGoogle Scholar
  7. 7.
    Skinner AV, Lauder GR. Rectus sheath block: successful use in the chronic pain management of pediatric abdominal wall pain. Paediatr Anaesth. 2007;17:1203–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Applegate WV, Buckwalter NR. Microanatomy of the structures contributing to abdominal cutaneous nerve entrapment syndrome. J Am Board Fam Pract. 1997;10(5):329–32.PubMedGoogle Scholar
  9. 9.
    Guittet L, Bouvier V, Mariotte N, et al. Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk population. Gut. 2007;56:210–4.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hogan Q, Abram S. Neural blockade for diagnosis and prognosis: a review. Anesthesiology. 1997;86:216–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Conwell DL, Vargo JJ, Zuccaro G, et al. Role of differential neuroaxial blockade in the evaluation and management of pain in chronic pancreatitis. Am J Gastroenterol. 2001;96:431–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Bradley EL, Reynhout JA, Peer GL. Thorascopic splanchnicectomy for a small duct chronic pancreatitis: case selection by differential epidural anesthesia. J Gastrointest Surg. 1998;2:88–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Soliman LM, Narouze S. Ultrasound-guided transversus abdominus plan block for the management of abdominal pain: an alternative to differential epidural block. Thech Reg Anesth Pain Manag. 2009;13:117–20.CrossRefGoogle Scholar
  14. 14.
    Simpson DM, Tyrrel J, De Ruiter J, Campbell FA. Use of ultrasound-guided treansversus abdominis plane blocks in a pediatric patient with chronic abdominal wall pain. Paediatr Anaesth. 2011;21:88–90.PubMedCrossRefGoogle Scholar
  15. 15.
    McDonnell JG, O’Donnell BD, Farrell T, Gough N, Tuite D, Power C, Laffey JG. Transversus abdominis plane block: a cadaveric and radiologic evaluation. Reg Anesth Pain Med. 2007;32:399–404.PubMedGoogle Scholar
  16. 16.
    Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anesth Analg. 2008;106(2):674–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Richardson J, Lonnqvist PA, Naja Z. Bilateral thoracic paravertebral block: potential and practice. Br J Anaesth. 2011;106(2):164–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Richardson J, Sabanathan S, Jones J, Shah RD, Cheema S, Mearns AJ. A prospective randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on postthoracotomy pain, pulmonary function and stress responses. Br J Anaesth. 1999;83:387–92.PubMedCrossRefGoogle Scholar
  19. 19.
    Thavaneswaran P, Rudkin G, Cooter RD, Moyes DG, Perera CL, Maddern GJ. Brief reports: paravertebral block for anesthesia: a systematic review. Anesth Analg. 2010;110(6):1740–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Naja ZM, Al-Tannir MA, Zeidan A, El-Rajab M, Ziade F, Baraka A. Nerve stimulator-guided repetitive paravertebral block for thoracic myofascial pain syndrome. Pain Pract. 2007;7:348–51.PubMedCrossRefGoogle Scholar
  21. 21.
    Krames ES, Foreman R. Spinal cord stimulation modulates visceral nociception and hyperalgesia via the postsynaptic dorsal column pathways: a literature review and hypothesis. Neuromodulation. 2007;10:224–37.PubMedCrossRefGoogle Scholar
  22. 22.
    Kapural L, Deer T, Yakovlev A, Bensitel T, Hayek S, Pyles S, et al. Technical aspects of spinal cord stimulation for managing chronic visceral abdominal pain. Pain Med. 2010;11:685–91.PubMedCrossRefGoogle Scholar
  23. 23.
    Tiede JM, Ghazi SM, Lamer TJ, Obray JB. The use of spinal cord stimulation in refractory abdominal visceral pain: case reports and literature review. Pain Pract. 2006;6:197–202.PubMedCrossRefGoogle Scholar
  24. 24.
    Kapural L, Nagem H, Tlucker H, Sessler DI. Spinal cord stimulation for chronic vesceral abdominal pain. Pain Med. 2010;11:347–55.PubMedCrossRefGoogle Scholar
  25. 25.
    Day M. Sympathetic blocks: the evidence. Pain Pract. 2008;8(2):98–109.PubMedCrossRefGoogle Scholar
  26. 26.
    Reisfield GM, Wilson GR. Blocks of the sympathetic axis for visceral pain, 2nd edition #97. J Palliat Med. 2011;14(4):510–1.PubMedCrossRefGoogle Scholar
  27. 27.
    Plancarte-Sanchez R, Guajardo-Rosas J, Guillen-Nunez R. Sympathetic block: thoracic and lumbar. Tech Reg Anesth Pain Manag. 2005;9:91–6.CrossRefGoogle Scholar
  28. 28.
    Carroll I. Celiac plexus block for visceral pain. Curr Pain Headache Rep. 2006;10:20–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg. 1995;80:290–5.PubMedGoogle Scholar
  30. 30.
    Staats PS, Yearwood T, Charapata SG, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA. 2004;291:63–70.PubMedCrossRefGoogle Scholar
  31. 31.
    Wong GY, Schroeder DR, Carns PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer. JAMA. 2004;291:1092–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Sharfman WH, Walsh TD. Has the analgesic efficacy of neurolytic celiac plexus block been demonstrated in pancreatic cancer pain? Pain. 1990;41:267–371.PubMedCrossRefGoogle Scholar
  33. 33.
    de Oliveira R, dos Reis MP, Prado WA. The effect of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain. 2004;110:400–8.PubMedCrossRefGoogle Scholar
  34. 34.
    de Leon-Casasola OA. Critical evaluation of chemical neurolysis of the sympathetic axis for cancer pain. Cancer Control. 2000;7:142–8.PubMedGoogle Scholar
  35. 35.
    Dravid RM, Paul RE. Interpleural block—part 1. Anaesthesia. 2007;62:1039–49.PubMedCrossRefGoogle Scholar
  36. 36.
    Dravid RM, Paul RE. Interpleural block—part 2. Anaesthesia. 2007;62:1143–53.PubMedCrossRefGoogle Scholar
  37. 37.
    Van Zundert J, Raj P, Erdine S, van Kleef M. Application of radiofrequency treatment in practical pain management: state of the Art. Pain Pract. 2002;2:269–78.PubMedCrossRefGoogle Scholar
  38. 38.
    Raj PP, Sahinler B, Lowe M. Radiofrequency lesioning of splanchnic nerves. Pain Pract. 2002;2:241–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Erdine S, De Andres J. Drug delivery system. Pain Pract. 2006;6:51–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Bennett G, Serafini M, Burchiel K, Buchser E, Classen A, Deer T, Du Pen S, Ferrante FM, Hassenbusch SJ, Lou L, Maeyaert J, Penn R, Portenoy RK, Rauck R, Willis KD, Yaksh T. Evidence-based review of the literature on intrathecal delivery of pain medication. J Pain Symptom Manage. 2000;20(2):S12–36.PubMedCrossRefGoogle Scholar
  41. 41.
    Guttman OT, Rosenblatt MA, Mims T. Median arcuate ligament syndrome—a novel treatment using an intrathecal morphine pump to relieve intractable visceral pain. Pain Pract. 2008;8:133–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Greenstein AJ, O’Rourke RW. Abdominal pain after gastric bypass: suspect and solutions. Am J Surg. 2011;201:819–27.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Kumar S, Wong PF, Leaper DJ. Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intenstinal obstruction after non-gynaecological abdominal surgery. Cochrane Database Syst Rev. 2009;1, CD 005080. doi:10.1002/14651858.pub2.Google Scholar
  44. 44.
    Ahmad G, Duffy JMN, Vail A, Vanderkerchove P, Watson A, Wiseman D. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2008;2, CD000475. doi: 10.1002/14651858.CD00475.pub2.PubMedGoogle Scholar
  45. 45.
    Lauder CIW, Garcea G, Strickland A, Maddern GJ. Abdominal adhesion prevention: still a sticky subject? Dig Surg. 2010;27:237–58.CrossRefGoogle Scholar
  46. 46.
    Metawally M, Watson A, Lilford R, Vanderkerchove P. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2006;2, CD001298. doi: 10.1002/14651858. CD001298.pub3.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jose De Andres
    • 1
    • 2
  • Luciano Perotti
    • 3
  • Stefano Palmisani
    • 4
    • 5
  • Vicente Luis Villanueva Perez
    • 2
  • Juan Marcos Asensio-Samper
    • 2
  • Gustavo Fabregat
    • 2
  1. 1.Anesthesia Division, Department of SurgeryValencia School of MedicineValenciaSpain
  2. 2.Anesthesia Critical Care and Pain Management DepartmentGeneral University HospitalValenciaSpain
  3. 3.Department of Anesthesia and Intensive CareCivil Hospital of VigevanoVigevanoItaly
  4. 4.Guy’s and St Thomas’ HospitalLondonUK
  5. 5.Pain Management and Neuromodulation CentreLondonUK

Personalised recommendations