tailieunhanh - Advanced Therapy in Gastroenterology and Liver Disease - part 4

Công nhận những căng thẳng một mình có thể không được đủ để làm thay đổi tần số và mức độ nghiêm trọng của cơn đau, và những bệnh nhân này có thể cần kiểm tra tâm lý để cung cấp thông tin bổ sung, chẳng hạn như đối phó và kỹ năng giải quyết vấn đề | 248 Advanced Therapy in Gastroenterology and Liver Disease Treatment of Moderate-to-Severe Recurrent Abdominal Pain Recognition of stressors alone may not be sufficient to alter the frequency and severity of the pain and these patients may need psychological testing to provide additional information such as coping and problem-solving skills symptoms and problems that might not have been previously determined and other possible sources of stress. Academic testing assesses whether the child is functioning at grade level and at the expected developmental level. Learning and communication disorders might hinder academic performance and contribute to stress. The goal of this testing is to assess whether there are previously unrecognized biological cognitive emotional academic and or social problems that might have been caused by or might contribute to a patient s stress and consequently lead to pain and disability. Although time consuming and expensive testing is essential when a child s abdominal pain is overwhelming and disabling and fails to respond to the usual recommended measures. Unified Plan Ideally pharmacologic psychological and physical interventions can be combined into a unified plan. Pain must be accepted as a symptom that might not be totally eradicated and the goal of treatment focused on improvement or lifestyle and coping skills improve pain may remit. Medications Tricyclic antidepressants such as amitryptyline Elavil are commonly used in chronic pain. This class of drugs has the added benefit of causing sedation as a side effect. However they should be used at lowest possible doses to avoid early morning sedation and are best given before bedtime. Selective serotonin reuptake inhibitors such as fluoxetine Prozac paroxetine Paxil and sertraline Zoloft do not show direct analgesic effects but can be helpful when depression or anxiety contribute to the abdominal pain. Clonidine Catapres a central a-adrenergic agent can help wean a child .