What are the treatments for abdominal pain?

From the Guidelines

Treatments for abdominal pain should prioritize soluble fibre, such as ispaghula, as a first-line option, commenced at a low dose of 3–4 g/day and gradually increased to avoid bloating, as recommended by the British Society of Gastroenterology guidelines on the management of irritable bowel syndrome 1. When considering treatments for abdominal pain, it's essential to identify the underlying cause, as this will guide the most effective approach. For mild pain, over-the-counter medications like acetaminophen (Tylenol) at 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) at 200-400mg every 4-6 hours can provide relief. Some key points to consider in managing abdominal pain include:

• Dietary modifications, such as avoiding spicy, fatty foods, and alcohol, and staying hydrated with clear fluids, can be beneficial.
• Antacids like Tums or Pepto-Bismol may help with indigestion-related pain.
• Heat therapy using a heating pad set on low for 15-20 minutes can relax muscles and reduce cramping.
• For gas-related discomfort, simethicone (Gas-X) 125-250mg after meals can help.
• Rest is important during episodes of abdominal pain to allow the body to heal. If pain is severe, persistent, accompanied by fever, vomiting, or bloody stool, or if you're pregnant or have underlying health conditions, seek immediate medical attention as these may indicate serious conditions requiring specific treatments like antibiotics, surgery, or other interventions. The use of antispasmodics, such as dicycloverine, propantheline, otilonium bromide, and hyoscine butylbromide, may also be considered for the relief of global symptoms and abdominal pain in IBS, although their effectiveness can vary and they may have side effects like dry mouth, visual disturbance, and dizziness 1. It's also worth noting that certain medications like loperamide may be effective for diarrhea in IBS but can have side effects like abdominal pain, bloating, nausea, and constipation, which may limit tolerability 1. In terms of more recent guidelines, the AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation suggests that antispasmodics are commonly used in clinical practice to reduce abdominal pain associated with IBS, although their regular use in constipation may be limited due to anticholinergic effects 1. Additionally, the AGA clinical practice update on management of chronic gastrointestinal pain in disorders of gut-brain interaction highlights the complexity of managing patients with pain that does not respond to first-line therapies directed at visceral stimuli, and the need for a comprehensive approach that considers cognitive, affective, and behavioral factors 1. Overall, the management of abdominal pain requires a tailored approach that takes into account the underlying cause, severity, and individual patient factors, and may involve a combination of dietary modifications, medications, and other therapies.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatments for Abdominal Pain

• The primary task in treating abdominal pain is to determine the underlying cause and degree of emergency, and then adapt therapeutic measures accordingly 2.
• For functional bowel disorders, the therapeutic focus is on symptom-oriented treatment, as causal therapy is limited 2.
• A systematic approach to evaluating patients with abdominal pain can help generate a differential diagnosis and ensure appropriate treatment 3.

Pharmacologic Therapies

• Antispasmodics, such as myorelaxants and peppermint oil, are used to treat abdominal pain, but their efficacy is debated 4, 5.
• Tricyclic antidepressants and selective serotonin reuptake inhibitors may be useful in treating abdominal pain, but their use is limited by side effects and patient concerns 5.
• Opioid agonists, such as loperamide, are useful for diarrhea but not for pain in irritable bowel syndrome (IBS) 4, 5.
• Alosetron, a 5HT(3) antagonist, is effective in reducing bowel frequency, improving stool consistency, and relieving abdominal pain in women with diarrhea-predominant IBS, but its use is restricted due to concerns about ischemic colitis 4, 5.

Non-Pharmacologic Therapies

• Cognitive interventions, such as cognitive behavioral therapy and hypnotherapy, have demonstrated excellent results in IBS patients, but their availability and labor-intensive nature limit their routine use 6.
• A diet low in fermentable carbohydrates and polyols (FODMAP) may be effective in reducing abdominal pain, bloating, and improving stool pattern in subgroups of patients 6.
• Fiber, such as isphagula, may be somewhat beneficial in reducing abdominal pain, but the evidence is limited 6.
• Probiotics may be effective, but their efficacy is difficult to interpret due to the variety of strains and quantities used across studies 6.