Lower Abdominal, Lower Back Pain for 4 Years - Undiagnosed


Q: Hello,

When I was 15, I had an appendectomy. The procedure went well and I recovered quickly. About three months later, a very similar lower right abdominal pain began. (It was very similar to the pain I had experienced from having appendicitis). I am now 19, and since that day the pain I have experienced has never receded below a 2/10 and generally I live in pain at around a 4 to 6/10 on a daily basis, with some days spiking up as high as 8 or 9/10. I have not had 1 day without pain since this started.

The pain is located not he lower right quadrant of my abdomen. It radiates upwards around the edge of my rib-cage, and to my left side in the same place. The center of my abdomen (around my naval) generally is not in pain. The pain also goes to my lower back. The PT as well as others I have seen have noted that my right side of my back is noticeably larger than my left (which has occurred since the pain has started).

Activity (especially running or walking) increases the pain very quickly. Some fatty "heavy" foods also will increase the pain (french fries, cake, etc.).

The only medication so far that has decreased the pain is Vicodin, something I do not wish to become attached to.

During these four years I have been to multiple GI Specialists, PTs and General Practitioners. I have had essentially every test administered on me (CT, X-Ray, MRI, HIDA, CBC, Lipase, Ultrasounds (4), Colonoscopy (2), Endoscopy (2), Capsule Endoscopy, all blood, urine and fecal workups... and the list goes on and on and on). I have been prescribed medication ranging from Tylenol (at very high doses) to muscle relaxants, antibiotics, and even been given medications that were used for off-label reasons. I have also tried less traditional methods including herbs, probiotics, etc.

I have never been given a diagnosis as no diagnosis has been found.

I have also tried both more focused work including seeing a massage therapist, acupuncturist, and I even went to a pain center (NYU Langone) where, unfortunately, I had one of the worst experiences with a doctor there that I have had anywhere.

Nothing has worked.

I am looking for other suggestions. Other places to look. I like in New York City, and I am only 19. This has been a huge struggle for me to live with for the last four years, and I am willing to try just about anything if there's a chance it will help.

Thank you for your time and help with this.

Symptoms:  Pain, lower right, lower left abdomen; lower back (across). Pain feels like a cramp one would get from activity, but much more severe

A:   Thank you for your question. We are very sorry you are experiencing such pain at such a young age. Since you have undergone many different evaluations for this pain without any diagnosis it would be very hard to suggest another possibility without further physical examination and testing. You did not mention if any of your doctors would have suggested that your pain could have been caused by scar tissue or nerve damage within your abdomen, so we would like to suggest this as a possibility. You may be frustrated that you have not arrived at a diagnosis as of yet, but we do encourage to keep consulting doctors in your area until you arrive at a diagnosis and treatment. A few specialists you may want to consider are gastroenterologists who will continue the investigations into a GI etiology of your pain, or a orthopedic surgeon who will investigate to see if your pain is originating in the are of your lumbar spine.

Thank you for consulting AskTheDoctor.com

Comments / Follow Ups

Patient: Hello,

Thank you for your response!

Scar tissue was looked into, and the massage was suggested as a more "gentle" way to try and work with that overtime. Unfortunately, it did not lead anywhere after about 3 or 4 months of work.

Nerve damage was considered by a pain center I worked with, but they ruled it out as they weren't able to find a single pinched or injured nerve, and wouldn't be able to treat it.

I will definitely consider looking into an orthopedic surgeon, would that be significantly different then working with a PT with a similar speciality?

Thank you for your time and help.

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