Taking a Medication History in Patients with Abdominal Pain
A thorough medication history is essential in patients with abdominal pain as medications can both cause abdominal pain and influence its management. This structured approach will help identify medication-related causes and guide treatment decisions.
Key Components of Medication History
Current Medications
- Prescription medications: Document name, dose, frequency, duration, and adherence
- Over-the-counter medications: Particularly NSAIDs, laxatives, antacids
- Supplements and herbal products: Many have gastrointestinal effects
- Recent medication changes: New medications or dosage adjustments in the past 2-4 weeks
Medication-Related Questions
- Medications that affect peristalsis: These are critical for differential diagnosis as they are associated with pseudo-obstruction and adynamic ileus 1
- Pain medications: Current analgesic use, effectiveness, and timing of last dose
- Medication allergies: Document specific reactions to medications
- Medication adherence: Assess if patient is taking medications as prescribed
Specific Medication Categories to Inquire About
Pain Medications
- Opioids: Can cause constipation, nausea, and ileus
- NSAIDs: Can cause gastritis, peptic ulcer disease, and exacerbate inflammatory bowel disease
- Acetaminophen: Document dosage to assess for potential hepatotoxicity
Gastrointestinal Medications
- Antacids/PPIs/H2 blockers: May mask symptoms of serious conditions
- Laxatives/stool softeners: Chronic use can affect bowel function
- Antidiarrheals: Can precipitate toxic megacolon in inflammatory conditions
Cardiovascular Medications
- Diuretics: Can cause electrolyte abnormalities affecting bowel function
- Calcium channel blockers: May cause constipation
- Anticoagulants: Increase risk of gastrointestinal bleeding
Other Important Medications
- Antibiotics: Recent use may suggest Clostridioides difficile infection
- Immunosuppressants: May mask signs of infection or inflammation
- Diabetic medications: Metformin can cause diarrhea; insulin regimens affect eating patterns
Special Considerations
Irritable Bowel Syndrome (IBS)
- Document use of IBS-specific medications (linaclotide, plecanatide, eluxadoline, rifaximin) 1
- Assess effectiveness of current regimen and side effects
Oncologic Emergencies
For patients with cancer-related pain:
- Document current pain management regimen
- Assess if pain is adequately controlled with current medications 1
- Determine if pain characteristics have changed, suggesting new pathology
Medication Timing in Relation to Pain
- When did symptoms begin relative to starting new medications?
- Does pain correlate with medication administration times?
- Has the patient missed doses of critical medications?
Documentation Best Practices
- Record medication history before ordering diagnostic tests to guide interpretation
- Document medication allergies prominently in the chart
- Verify medication list with multiple sources when possible (patient, family, pharmacy records, previous medical records)
- Reconcile medication lists at each transition of care
Pitfalls to Avoid
- Incomplete medication history: Missing over-the-counter medications or supplements
- Failure to ask about recent medication changes: New medications are common culprits
- Not considering medication side effects: Many medications can cause or exacerbate abdominal pain
- Overlooking medication adherence issues: Non-adherence can lead to disease exacerbation
By systematically obtaining a comprehensive medication history using this approach, clinicians can identify potential medication-related causes of abdominal pain and make informed decisions about diagnostic testing and management strategies 2.