Decoding Abdominal Pain
By Sara Calabro
The New York Times last week, in the headline to an article about enigmatic cases of abdominal pain, hailed “due diligence” as an appropriate “prescription.” Acupuncture is another.
Conditions for which standard medical tests fail to provide answers often send patients down a frustrating path. When biomedicine’s go-to diagnostic tools turn up nothing, treatment recommendations are challenging, leading to excessive testing and shot-in-the-dark prescription writing—often to no avail.
Abdominal pain frequently falls into this category and has proved an especially tough nut for biomedicine to crack. The established (yet not fully understood) brain-gut connection makes abdominal disorders harder to pin down than those that are more easily identifiable on an X-ray or blood test.
These types of conditions, ones that remain largely mysterious within biomedical paradigms, are often what lead people to acupuncture. And abdominal disorders—pain, as well as pressure and bloating, diarrhea, food intolerance, nausea and vomiting, and heartburn—are extremely common complaints in acupuncture clinics.
It is unfortunate that so many people find themselves there as a last resort, as acupuncture as a first-line treatment for abdominal pain could help lower spending on redundant specialist visits and decrease side effects from unnecessary medications.
Consider the Big Picture
The physician author of the Times piece admits, “When I was a resident, we often smirked when we spoke of functional abdominal pain, treating it as a code for a troublesome patient, dubious symptoms or an anxious family. But recent research suggests we were too biomedically narrow in our thinking.”
A gastroenterologist interviewed for the article says the more modern biomedical approach to abdominal pain is to “think in terms of a biological-psychological-social model.”
Welcome to Acupuncture 101.
Acupuncture is premised on the idea that the human body is comprised of interdependent physical structures whose condition is affected by emotional and environmental factors. Diagnostic methods reflect this perspective on disease etiology, and therefore include assessing a number of areas that may seem irrelevant within a biomedical context: sleep, body temperature, menstruation in women, eye sight, hearing, among many others.
Abdominal disorders, because they often contain an emotional component, are particularly good candidates for medicines like acupuncture that think holistically about illness and avoid one-size-fits all approaches.
Abdominal Pain Triggers
Acupuncture points for abdominal pain are not exclusively on the midsection—in fact, the majority of needles might be placed on the arms and legs, below the elbows and knees. However, acupuncturists trained in trigger-point needling may also address the pain locally.
Myofascial trigger points are hypersensitive spots in the muscle that cause referred pain or weakness. And trigger points in the abdominal muscles can cause upper abdominal pain (see picture at right, of the external oblique pain-referral pattern) or lower abdominal and/or groin pain (from trigger points in the lateral abdominals, not shown). Releasing these spots (“X” on the picture) with acupuncture can alleviate pain, sometimes instantly.
It also can help with non-pain abdominal symptoms such as diarrhea, nausea and vomiting, and heartburn. Janet Travell, in her book Myofascial Pain and Dysfunction: The Trigger Point Manual, refers to this concept as “somatovisceral,” meaning muscular dysfunction (i.e., trigger points) can cause visceral symptoms. The idea also works the other way around—what Travell calls “viscerosomatic”—where visceral disease causes or exacerbates trigger points, resulting in muscular pain, weakness, or decreased range of motion.
Travell says, “Understanding the reciprocal somatovisceral and viscerosomatic effects of [trigger points] helps to unravel some of this uncertainty” associated with abdominal pain.
But even Travell, a biomedical physician and the guru of palpable diagnosis, acknowledges emotional involvement in cases of recurrent abdominal pain. In her book, when pointing out corrective actions for abdominal trigger points, she says, “Laughter is good medicine.” So is acupuncture.
Photo by Sara Calabro