Psychogenic considerations

Psychogenic factors can be most relevant especially in recurrent or chronic abdominal pain where no specific cause can be identified in most cases. 5 Bain and Spaulding found that 40% of presenting adult abdominal pain had nonstructural causes with 28% having psychiatric diagnoses and 6% spastic colon. They noted that 'psychological disturbances are often fairly easy to identify if care is taken to obtain the personal history and to assess the patient's personality, but the diagnostic terms used to describe psychological disturbances lack precision'.

Table 30.4 Drugs to consider as a cause of abdominal pain

Alcohol

Antibiotics, e.g. erythromycin Aspirin

Corticosteroids Cytotoxic agents

Tricyclic antidepressants, e.g. imipramine

Iron preparations

Nicotine

NSAIDs

Sodium valproate Phenytoin

Fig. 30.1 Referred pain patterns to the anterior abdominal wall from dysfunction of the thoracic spine via anterior cutaneous branches of the nerve roots (right side). Note the possibility of confusion with

biliary pain, appendicitis and inguinal disorders

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