Does pancreatitis cause functional abdominal pain and IBS?
Question - I have a 10-year-old son who had pancreatitis almost two years ago. He has had so much testing done and a cholecystectomy since then. He has had pain since the pancreatic episode. The pain is unbearable at night. During the day, he seems to keep his mind busy enough that it doesn’t hurt as bad... But there are days (and a lot of times after eating) that the pain occurs. It wakes him up.
We’ve seen a few GI doctors and they claim it is functional abdominal pain and IBS. Are these diagnoses because they can’t figure it out? Or does pancreatitis cause functional abdominal pain and IBS?
Answer - It’s complicated. When a person feels well, pain nerves are at rest, said to be sleeping, because they send no pain signals. Any pain experience wakes up sleeping pain nerves and the nerves send pain messages to the brain. In most cases when the cause for the pain is over, the pain nerves go back to sleep.
When pain nerves stay sensitized even after the cause is gone, the result is neuropathic pain, or pain that arises from hypersensitive nerves. Maybe the pancreatitis woke your son’s pain nerves, and those pain nerves persist in sending pain messages to the brain even after evidence for disease is gone.
Most GI clinicians are able to find the cause for pain caused by a disease. Your son has had many tests to look for disease, but no disease is apparent at the present time. The absence of easily found disease makes functional or neuropathic pain a probable cause for your son’s persistent symptoms. There are no tests for functional, neuropathic pain. The treatment for functional pain is often effective in a matter of weeks.
The first thing to do is regulate sleep so that your son sleeps comfortably through the night and wakes refreshed in the morning. We use a medicine for chronic pain that has sedating properties so that the right dose is the one where sleep is without discomfort or interruption.
The second part to treatment is teaching your son coping skills so that he has ways to help himself reduce the pain sensations. These instructions are taught to your child by a child psychologist using a method called cognitive behavioral therapy or CBT.
There is nothing to lose from a treatment trial for functional pain. If it works, that’s great. If it does not work, the next steps for treating pancreatic pain are more invasive.
– Paul E. Hyman, MD