If one reads the literature on the therapy of chronic abdominal pain, one quickly finds a commonality: the pain is considered to be extremely difficult to treat. Whether chronic prostatitis, vulvodynia, vestibulitis or irritable bladder - all diseases are considered therapeutically "ungrateful".
As with other functional complaints
The reason is comparatively simple. The complaints are not (or only to a small extent) caused by a change in the local tissue. The actual cause lies in the change of the peripheral and/or central stimulus threshold. The result is excessive sensitization, i.e. real (not imagined) hypersensitivity of the corresponding region.
This type of change can be seen poorly or not at all on physical examination, they do not present themselves on X-ray, ultrasound or laboratory tests.
Accordingly, even local treatments rarely bring about an improvement, which is frustrating for doctors and patients alike.
All too often, the medical profession tends to attribute the symptoms, which do not seem to have a clear cause, solely to psychological factors. Those affected are advised to consult a psychotherapist or psychiatrist. If one merely receives medication there, e.g. antidepressants, this rarely changes anything about the pain. Sometimes the side effects are stronger than the symptom relief.
Of course, pain also has psychological causes. As mentioned, anxiety, inner tension, chronic stress or depression exacerbate a pain disorder. In this respect, it can be very useful to include psychotherapeutic elements in a more comprehensive treatment concept. However, psychotherapy alone and, in particular, exclusive treatment with antidepressants (drugs for depression) very rarely lead to success.
"Gold standard" multimodal therapy
Successful therapeutic strategies, however, take a somewhat different approach. An attempt is made to gradually raise the lowered stimulus threshold in order to achieve lasting freedom from symptoms. Especially multimodal (multi=many, modus=way) therapy methods are effective, which rely on more than one therapy method.
One of the great difficulties in the therapy of abdominal pain is that the obvious therapeutic procedures are largely ineffective, and may even aggravate the discomfort.
For example, if there is severe discomfort from vulvodynia or vestibulitis, then many local therapies will cause the discomfort to worsen. Treatment or diagnostic interventions only further lower the threshold of irritation, further exacerbating the pain.
This fact puts many sufferers in great perplexity as they wonder what else they can do. Often the perineal region is so painful that any touch - let alone treatment - causes pain.
Direct or perineal?
As shown above, most types of abdominal pain do not occur in complete isolation. They are often accompanied by other pains or conditions that contribute to or exacerbate them. For the person concerned, it is bad to have so many complaints. However, this fact can be used extremely productively for therapy.
If one suffers from several types of pain, (e.g. back pain and pain in the abdomen), one will notice that these pains often increase or decrease together.
It may be that one region (such as perineum/vulva/anus) is so extremely sensitized that any therapy here is impossible. In such cases, one will try to prioritize other pains first, such as back pain or intestinal discomfort.
If one succeeds in alleviating these other complaints, one is often surprised to find that the "actual" pain has also improved. In short, the pain thresholds in different areas are interconnected. Thus, apparent detours lead more quickly to the goal.
In everyday clinical practice, there are usually more than two symptomatologies. Often there are numerous complaints from which the affected person suffers. The medical art is to treat the essential complaints in the right order. If a doctor prescribes too many or the wrong procedures, the symptoms will increase; if he prescribes too few or the wrong ones, they will not improve.
How a treatment is designed in detail depends on the individual case. However, experience shows that the quality of sleep, the condition of the gastrointestinal tract, the absence of muscle or joint pain, and the reduction of anxiety are essential elements of therapy in most cases.
Many sufferers complain of increased sensitivity to cold and/or heat. This usually has nothing to do with body weight, but with the lowered stimulus threshold for heat and cold stimuli. If the stimulus threshold can be raised (by alternating heat and cold therapy), this also has an effect on the pain threshold, and the general hypersensitivity decreases. A fact that used to be called "hardening" or "roborating".
Equally important: respiratory therapy. Here we almost always find abnormalities, especially in the form of accelerated, restless breathing. Also because of the close relationship between the pelvic floor and the diaphragm, which oppose each other as antagonists, respiratory therapy has a very beneficial effect here.
If the complaints have become chronic over a longer period of time, intensive treatments are often necessary in order to effectively break the vicious circle of pain. From our experience, 2-3 week treatments are useful in order to achieve significant therapeutic progress.
Depending on the possibilities, we then extend the therapy intervals or switch completely to self-help or therapy at the place of residence.