Real Issues of abdominal pains claimed by injured workers, related to work accident
Said Rahban, MD, FACP, AGAF, QME
Diplomate American Board of Gastroenterology Assistant Clinical Professor at Geffen Medical School
6333 Wilshire Blvd, #414, Los Angeles, CA 90048 Phone: 323.852.1751
Abdominal pain is a rather common symptom that injured workers often complain of. The causes of abdominal pains are numerous and probably most of them are not related to work injuries, but rather the aftermath of life or side effects of medications that could be considered as an aggravating factor for their development.
Generally, the causes of abdominal pain are gallbladder disease (gallstones), pancreatic inflammation (pancreatitis) or other inflammatory processes such as colitis etc. that are considered innate unless an aggravating factor related to a work accident may have aggravated/exacerbated these conditions to develop and manifest their abdominal pains reported by the applicant.
Occasionally, there are rare issues that a work accident can cause such as hepatitis, pancreatitis or colitis. These problems are sometimes caused by the side effects of medications such as non-steroidal anti-inflammatory agents like Ibuprofen, Naproxen etc. or the worker was exposed to a causal factor at work. A specialist in gastroenterology who is familiar with W/C laws, and medical conditions, can immediately separate the causes of abdominal pain from pre-existing conditions, and a real work injury through the appropriate diagnostic tests to prove or deny the relationship of these GI problems to the work injury. A thorough and extensive review of available medical records from present, and past health conditions of the injured employee is needed to complete an appropriate assessment of the condition.
Common work related abdominal pains are often pains related to peptic ulcers in the stomach or heartburn (acid reflux disease, GERDs), and can be the result of the side effects of anti-inflammatory agents, NSAIDs, anxiety, stress and obesity. This pain is mostly felt over the upper part of the abdomen in the center below the sternal bone (wish bone) occasionally radiating towards the chest as well. Sometimes the applicant may have had these conditions prior to the injury, and the pain has been exacerbated by the medication’s side effects or the presence of a Hiatal Hernia (stomach hernia) that is an anatomic abnormality, also known as an aggravating factor for heartburn. A Hiatal Hernia is considered a non-work injury related condition. For an exact diagnosis of these pains, an upper GI endoscopy is recommended. This test also evaluates the possibility of Helicobacter infection in the stomach. This type of infection is a non-industrial condition, and is rather common in injured workers due to prior consumption of infected foods or water.
These conditions can all be treated with proper medications.
The other common cause of abdominal pains that could also be associated with change of bowl movements such as diarrhea or constipation and gas, is known as Irritable Bowel Syndrome (IBS) that often is aggravated by anxiety, stress, and side effects of medications like NSAIDs or analgesics. Though it is also an innate condition, and mostly depending on the abnormal motility of muscles pacemakers in GI tract, however the medications and other stresses related to work accident may give rise for its appearance as this is also common in western countries due to increased stresses in daily life. IBS is usually aggravated by stress due to loss of job, pains from injured area, and economic problems that they must deal with after injury.
Another rather rare but important condition that may appear after injury is when the applicant has been treated with strong pain medications, and opioids such as codeine containing drugs, called Narcotic Bowel Syndrome (NBS) in the GI literature. NBS could indeed cause more abdominal pains when it is used for long period of time by the injured worker. IBS and NBS however, can be adequately treated if diagnosed correctly.
References:
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Jung-Hwan Oh*, Tae-Suk Kim†, Myung-Gyu Choi*, Hyeug Lee*, Eun-Jung Jeon*, Sang-Wook Choi*, Chul Lee†, and In-Sik Chung*Departments of *Internal Medicine and †Psychiatry, The Catholic University of Korea School of Medicine, Seoul, Korea-Gut and Liver, Vol. 3, No. 4, December 2009, pp. 259-265
2.-Laine L. Approaches to non-steroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology 2001; 120: 594–606
3-Vanvick PO et al. Prevalence, comorbidity and impact of irritable bowel syndrome in Norway. Scan J Gastroenterology; 41:650-656
4-Grunkemeier DMS, Cassara JE, Dalton CB, Drossman DA. The narcotic bowel syndrome: clinical features, pathophysiology, and management. Clinical Gastroenterology-Hepatology 2007;5:1126-1139.
