Understanding Constant Abdominal Pain: A Comprehensive Guide for Patients

May 10, 2024

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Constant abdominal pain, also known as chronic abdominal pain, is a common and often debilitating condition that affects many people worldwide. As a medical professional, it is essential to provide patients with accurate and accessible information about this condition, its causes, symptoms, and available treatment options.

In this comprehensive guide, we will explore the various aspects of constant abdominal pain, including its definition, prevalence, risk factors, and the different conditions that can cause it. We will also discuss the diagnostic process, treatment options, and self-care strategies that can help patients manage their symptoms and improve their quality of life.

What is Constant Abdominal Pain?

Constant abdominal pain refers to persistent or recurrent discomfort in the abdominal region that lasts for at least three months[1]. This type of pain can vary in intensity and location, and may be accompanied by other symptoms such as bloating, nausea, vomiting, or changes in bowel habits.

It is important to note that constant abdominal pain is not a diagnosis in itself, but rather a symptom of an underlying condition. Identifying the root cause of the pain is crucial for developing an effective treatment plan and improving the patient’s overall well-being.

Prevalence and Risk Factors

Constant abdominal pain is a prevalent issue, affecting approximately 10-15% of the general population[2]. While it can occur in people of all ages, it is more common in women and those over the age of 50.

Several risk factors can increase an individual’s likelihood of developing chronic abdominal pain, including:

  • Family history of gastrointestinal disorders
  • Personal history of abdominal surgeries or injuries
  • Chronic stress or anxiety
  • Poor dietary habits
  • Sedentary lifestyle

Understanding these risk factors can help patients and healthcare providers identify potential causes of constant abdominal pain and develop strategies for prevention and management.

Common Causes of Constant Abdominal Pain

Constant abdominal pain can be caused by a wide range of conditions, both gastrointestinal and non-gastrointestinal in nature. Some of the most common causes include:

  1. Irritable Bowel Syndrome (IBS)
  2. Inflammatory Bowel Disease (IBD)
  3. Chronic Pancreatitis
  4. Peptic Ulcer Disease
  5. Gastroesophageal Reflux Disease (GERD)
  6. Endometriosis
  7. Chronic Pelvic Pain Syndrome
  8. Abdominal Adhesions
  9. Celiac Disease
  10. Food Intolerances or Allergies

In the following sections, we will explore each of these conditions in more detail, discussing their specific symptoms, diagnostic criteria, and treatment options.

Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain, bloating, and changes in bowel habits. It affects approximately 10-15% of the population and is more common in women than men[3].

IBS is typically diagnosed based on the presence of specific symptoms, such as abdominal pain that is relieved by bowel movements, changes in stool frequency or consistency, and bloating. Treatment options for IBS include dietary modifications, stress management techniques, and medication to manage symptoms.

Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD) is a group of chronic inflammatory conditions that affect the gastrointestinal tract, primarily the small and large intestines. The two main types of IBD are Crohn’s disease and ulcerative colitis.

Symptoms of IBD can include abdominal pain, diarrhea, weight loss, and fatigue. Diagnosis typically involves a combination of clinical examination, blood tests, imaging studies, and endoscopic procedures. Treatment options for IBD include anti-inflammatory medications, immunosuppressants, and surgery in severe cases.

Chronic Pancreatitis

Chronic pancreatitis is a progressive inflammatory condition that leads to permanent damage to the pancreas. It is often caused by long-term alcohol abuse or genetic factors and can result in constant abdominal pain, particularly in the upper abdomen.

Other symptoms of chronic pancreatitis may include nausea, vomiting, weight loss, and steatorrhea (fatty stools). Diagnosis usually involves imaging studies such as CT scans or MRIs, as well as blood tests to assess pancreatic function. Treatment options include pain management, dietary modifications, enzyme replacement therapy, and surgery in some cases.

Peptic Ulcer Disease

Peptic ulcer disease refers to the development of open sores or ulcers in the lining of the stomach or duodenum (the first part of the small intestine). The most common causes of peptic ulcers are Helicobacter pylori (H. pylori) bacterial infection and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Symptoms of peptic ulcer disease include abdominal pain, typically described as a burning or gnawing sensation, as well as nausea, vomiting, and weight loss. Diagnosis involves upper endoscopy and testing for H. pylori infection. Treatment options include antibiotics to eradicate H. pylori, acid-reducing medications, and lifestyle modifications.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD) is a chronic digestive disorder characterized by the backflow of stomach acid into the esophagus, causing irritation and inflammation. This can lead to constant abdominal pain, heartburn, regurgitation, and difficulty swallowing.

Diagnosis of GERD typically involves a combination of symptom assessment, upper endoscopy, and pH monitoring. Treatment options include lifestyle modifications, such as avoiding trigger foods and losing weight, as well as medication to reduce acid production and improve esophageal motility.

Endometriosis

Endometriosis is a chronic gynecological condition in which tissue similar to the lining of the uterus grows outside the uterus, often on the ovaries, fallopian tubes, or other pelvic structures. This can cause constant abdominal pain, particularly during menstrual periods, as well as heavy menstrual bleeding and infertility.

Diagnosis of endometriosis often requires laparoscopic surgery to visualize and biopsy the abnormal tissue growth. Treatment options include hormonal therapy to suppress menstruation, pain management, and surgery to remove the endometrial tissue.

Chronic Pelvic Pain Syndrome

Chronic Pelvic Pain Syndrome (CPPS) is a condition characterized by persistent pain in the pelvic region that lasts for at least six months. It can affect both men and women and may be associated with urinary symptoms, sexual dysfunction, and psychological distress.

The exact cause of CPPS is often unknown, but it may be related to factors such as pelvic floor muscle dysfunction, nervous system sensitization, or underlying conditions like interstitial cystitis or prostatitis. Diagnosis typically involves a thorough medical history, physical examination, and imaging studies to rule out other causes of pelvic pain. Treatment options may include physical therapy, medication, and cognitive-behavioral therapy to manage pain and improve quality of life.

Abdominal Adhesions

Abdominal adhesions are bands of scar tissue that form between abdominal organs, often as a result of previous surgery, infection, or inflammation. These adhesions can cause constant abdominal pain, as well as bowel obstruction, infertility, and other complications.

Diagnosis of abdominal adhesions typically requires imaging studies such as CT scans or MRIs, as well as a careful review of the patient’s surgical history. Treatment options may include adhesiolysis surgery to remove the scar tissue, as well as pain management and dietary modifications to prevent bowel obstruction.

Celiac Disease

Celiac disease is an autoimmune disorder in which the consumption of gluten, a protein found in wheat, barley, and rye, triggers an immune response that damages the small intestine. This can lead to constant abdominal pain, diarrhea, bloating, and malnutrition.

Diagnosis of celiac disease involves blood tests to detect specific antibodies, as well as an upper endoscopy with biopsy to assess damage to the small intestine. The primary treatment for celiac disease is a strict gluten-free diet, which allows the small intestine to heal and improves symptoms.

Food Intolerances or Allergies

Food intolerances and allergies can cause constant abdominal pain, as well as other gastrointestinal symptoms like bloating, diarrhea, and nausea. Common food intolerances include lactose intolerance and fructose malabsorption, while food allergies can be triggered by a variety of foods, such as peanuts, shellfish, or eggs.

Diagnosis of food intolerances and allergies typically involves a combination of symptom assessment, food diaries, and elimination diets, as well as specific tests like breath hydrogen testing or skin prick tests. Treatment primarily involves avoiding trigger foods and working with a registered dietitian to ensure a balanced and nutritious diet.

Diagnostic Process for Constant Abdominal Pain

When a patient presents with constant abdominal pain, the diagnostic process typically involves several steps to identify the underlying cause and develop an appropriate treatment plan. These steps may include:

  1. Medical History and Physical Examination
  2. Laboratory Tests
  3. Imaging Studies
  4. Endoscopic Procedures
  5. Specialized Tests

In the following sections, we will discuss each of these diagnostic steps in more detail, highlighting their importance in the evaluation of constant abdominal pain.

Medical History and Physical Examination

The first step in diagnosing constant abdominal pain is a thorough medical history and physical examination. During the medical history, the healthcare provider will ask questions about the patient’s symptoms, including the location, duration, and character of the pain, as well as any associated symptoms like nausea, vomiting, or changes in bowel habits.

The physical examination will focus on the abdominal region, with the healthcare provider palpating the abdomen to assess for tenderness, masses, or organomegaly (enlargement of organs). They may also perform a digital rectal examination to check for abnormalities in the lower gastrointestinal tract.

Laboratory Tests

Blood tests can help identify underlying conditions that may be causing constant abdominal pain. Some common tests include:

  • Complete Blood Count (CBC) to check for anemia or infection
  • Comprehensive Metabolic Panel (CMP) to assess liver and kidney function
  • C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) to detect inflammation
  • Celiac Disease Antibody Tests to screen for celiac disease
  • Stool Tests to check for infections, parasites, or blood in the stool[4]

Based on the patient’s specific symptoms and medical history, additional specialized tests may be ordered to help narrow down the differential diagnosis.

Imaging Studies

Imaging studies can provide valuable information about the structure and function of the abdominal organs, helping to identify potential causes of constant abdominal pain. Some commonly used imaging modalities include:

  • Abdominal X-rays to detect bowel obstruction, perforations, or abnormal gas patterns
  • Ultrasound to visualize the gallbladder, liver, pancreas, and reproductive organs
  • Computed Tomography (CT) scans to evaluate the abdominal organs and detect masses or inflammation
  • Magnetic Resonance Imaging (MRI) to assess soft tissues and rule out conditions like endometriosis or abdominal adhesions

The choice of imaging study will depend on the patient’s specific symptoms, physical examination findings, and the suspected underlying condition.

Endoscopic Procedures

Endoscopic procedures allow direct visualization of the gastrointestinal tract and can help diagnose conditions such as peptic ulcer disease, inflammatory bowel disease, or celiac disease. The two main types of endoscopic procedures are:

  • Upper Endoscopy (Esophagogastroduodenoscopy or EGD): This procedure involves inserting a flexible tube with a camera through the mouth to examine the esophagus, stomach, and duodenum. Biopsies can be taken during the procedure for further analysis.
  • Colonoscopy: This procedure uses a flexible tube with a camera inserted through the rectum to examine the entire colon and rectum. Biopsies can be taken, and polyps can be removed during the procedure.

Endoscopic procedures are typically performed under sedation to ensure patient comfort and may require special preparation, such as fasting or bowel cleansing, prior to the procedure.

Specialized Tests

In some cases, additional specialized tests may be necessary to diagnose the underlying cause of constant abdominal pain. These tests may include:

  • Breath Hydrogen Testing to diagnose lactose intolerance or small intestinal bacterial overgrowth (SIBO)
  • Gastric Emptying Study to evaluate the motility of the stomach and rule out gastroparesis
  • Anorectal Manometry to assess the function of the anal sphincter and pelvic floor muscles
  • Laparoscopy to directly visualize the abdominal and pelvic organs and diagnose conditions like endometriosis or abdominal adhesions

These specialized tests are usually ordered by a gastroenterologist or other specialist based on the patient’s specific symptoms and the results of previous diagnostic tests.

Treatment Options for Constant Abdominal Pain

Once the underlying cause of constant abdominal pain has been identified, treatment options can be tailored to the specific condition and the patient’s individual needs. In general, treatment approaches may include:

  1. Lifestyle Modifications
  2. Dietary Changes
  3. Medications
  4. Psychological Therapies
  5. Complementary and Alternative Medicine
  6. Surgical Interventions

In the following sections, we will explore each of these treatment options in more detail, discussing their potential benefits and limitations in the management of constant abdominal pain.

Lifestyle Modifications

Lifestyle modifications can play a significant role in managing constant abdominal pain, particularly for conditions like GERD, IBS, and chronic pelvic pain syndrome. Some recommended lifestyle changes may include:

  • Maintaining a healthy weight through regular exercise and a balanced diet
  • Avoiding tobacco use and excessive alcohol consumption
  • Managing stress through relaxation techniques, such as deep breathing or meditation
  • Practicing good sleep hygiene to ensure adequate rest
  • Staying hydrated by drinking plenty of water throughout the day

Implementing these lifestyle changes can help reduce the frequency and severity of abdominal pain episodes and improve overall quality of life.

Dietary Changes

Dietary modifications can be an effective way to manage constant abdominal pain, especially for conditions like IBS, celiac disease, and food intolerances or allergies. Some common dietary strategies include:

  • Following a low-FODMAP diet, which restricts fermentable carbohydrates that can trigger IBS symptoms[5]
  • Adopting a gluten-free diet for patients with celiac disease
  • Eliminating trigger foods identified through food diaries or elimination diets
  • Increasing fiber intake to promote regular bowel movements and reduce constipation
  • Limiting spicy, fatty, or acidic foods that can exacerbate GERD symptoms

Working with a registered dietitian can help patients develop a personalized meal plan that addresses their specific dietary needs and restrictions.

Medications

Medications can be used to target specific symptoms or underlying conditions associated with constant abdominal pain. Some common types of medications include:

  • Antispasmodics to reduce abdominal cramping and pain in IBS
  • Proton Pump Inhibitors (PPIs) or H2 Blockers to reduce stomach acid production in GERD and peptic ulcer disease
  • Antibiotics to treat H. pylori infection in peptic ulcer disease or SIBO
  • Anti-inflammatory drugs, such as 5-ASA compounds or corticosteroids, to manage inflammation in IBD
  • Antidepressants, such as tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs), to modulate pain perception and improve mood in chronic pain conditions

The choice of medication will depend on the specific underlying condition, the severity of symptoms, and the patient’s overall health status. Regular follow-up with a healthcare provider is essential to monitor the effectiveness and potential side effects of prescribed medications.

Psychological Therapies

Psychological therapies can be beneficial for patients with constant abdominal pain, particularly those with conditions like IBS, chronic pelvic pain syndrome, or functional abdominal pain disorder. These therapies can help patients develop coping strategies, manage stress, and improve their overall well-being. Some common psychological therapies include:

  • Cognitive-Behavioral Therapy (CBT) to identify and change negative thought patterns and behaviors that contribute to pain perception
  • Relaxation Techniques, such as progressive muscle relaxation or guided imagery, to reduce stress and promote relaxation
  • Biofeedback to help patients learn to control physiological responses to pain or stress
  • Hypnotherapy to reduce pain perception and improve gut motility in IBS

Psychological therapies can be used in conjunction with other treatment modalities, such as medication or lifestyle modifications, to provide a comprehensive approach to managing constant abdominal pain.

Complementary and Alternative Medicine

Complementary and Alternative Medicine (CAM) therapies can be used alongside conventional medical treatments to help manage constant abdominal pain. Some commonly used CAM therapies include:

  • Acupuncture to stimulate specific points on the body and promote pain relief and relaxation
  • Herbal Remedies, such as peppermint oil or ginger, to reduce inflammation and soothe gastrointestinal symptoms
  • Massage Therapy to alleviate muscle tension and improve overall well-being
  • Yoga to promote relaxation, reduce stress, and improve flexibility and strength

While some CAM therapies have shown promise in managing abdominal pain, it is essential to discuss their use with a healthcare provider to ensure safety and avoid potential interactions with conventional treatments.

Surgical Interventions

In some cases, surgical interventions may be necessary to treat underlying conditions causing constant abdominal pain. Some examples of surgical procedures include:

  • Fundoplication to strengthen the lower esophageal sphincter and prevent acid reflux in GERD
  • Resection of the affected intestinal segment in severe cases of IBD or chronic pancreatitis
  • Adhesiolysis to remove abdominal adhesions causing pain and bowel obstruction
  • Laparoscopic excision of endometrial tissue in endometriosis

The decision to pursue surgical treatment will depend on the specific underlying condition, the severity of symptoms, and the patient’s response to other treatment modalities. A thorough discussion of the potential benefits and risks of surgery should take place between the patient and their healthcare provider.

Coping Strategies for Living with Constant Abdominal Pain

Living with constant abdominal pain can be challenging, both physically and emotionally. In addition to seeking medical treatment, patients can benefit from incorporating coping strategies into their daily lives to manage symptoms and improve their overall quality of life. Some effective coping strategies include:

  1. Keeping a Symptom Journal
  2. Practicing Mindfulness and Relaxation Techniques
  3. Engaging in Regular Physical Activity
  4. Joining a Support Group
  5. Communicating with Healthcare Providers

In the following sections, we will discuss each of these coping strategies in more detail, highlighting their potential benefits and providing practical tips for implementation.

Keeping a Symptom Journal

Maintaining a symptom journal can help patients identify potential triggers for their abdominal pain, track the effectiveness of treatments, and communicate more effectively with their healthcare providers. When keeping a symptom journal, patients should record:

  • The date and time of each pain episode
  • The location, intensity, and character of the pain
  • Any associated symptoms, such as nausea, vomiting, or changes in bowel habits
  • Potential triggers, such as specific foods, stressors, or activities
  • Medications taken and their effects on symptoms

Regularly reviewing the symptom journal can help patients recognize patterns and make lifestyle modifications to better manage their abdominal pain.

Practicing Mindfulness and Relaxation Techniques

Mindfulness and relaxation techniques can help patients cope with the stress and anxiety that often accompany constant abdominal pain. Some effective techniques include:

  • Deep Breathing Exercises to promote relaxation and reduce muscle tension
  • Progressive Muscle Relaxation to systematically tense and relax different muscle groups
  • Meditation to focus the mind, reduce stress, and promote a sense of calm
  • Guided Imagery to create mental images of peaceful, comforting scenes

Incorporating these techniques into a daily routine can help patients better manage their symptoms and improve their overall well-being.

Engaging in Regular Physical Activity

Regular physical activity can help alleviate symptoms of constant abdominal pain by reducing stress, improving mood, and promoting healthy bowel function. Low-impact activities, such as walking, swimming, or cycling, are generally well-tolerated by patients with abdominal pain.

Before starting an exercise program, patients should consult with their healthcare provider to ensure that the chosen activities are safe and appropriate for their specific condition. Gradually increasing the duration and intensity of exercise can help patients build tolerance and avoid exacerbating their symptoms.

Joining a Support Group

Joining a support group can provide patients with constant abdominal pain a sense of community, validation, and encouragement. Support groups can be in-person or online and may be specific to a particular underlying condition, such as IBS or endometriosis.

Participating in a support group can help patients:

  • Share their experiences and learn from others who are facing similar challenges
  • Access resources and information about managing their condition
  • Develop coping strategies and receive emotional support
  • Feel less isolated and more empowered in their journey to better health

Many national organizations, such as the International Foundation for Gastrointestinal Disorders (IFFGD) or the Endometriosis Association, offer support group resources for patients with constant abdominal pain.

Communicating with Healthcare Providers

Open and honest communication with healthcare providers is essential for effectively managing constant abdominal pain. Patients should:

  • Provide a detailed medical history, including all symptoms, triggers, and treatments tried
  • Ask questions and express concerns about their condition and treatment options
  • Follow up regularly to monitor progress and adjust treatment plans as needed
  • Inform their healthcare provider about any new symptoms, side effects, or changes in their condition

By establishing a strong partnership with their healthcare team, patients can work towards finding the most effective management strategies for their constant abdominal pain.

The Role of HF10 for Chronic Abdominal Pain Management

HF10 is a type of spinal cord stimulation (SCS) therapy that has shown promise in managing chronic abdominal pain[6]. SCS involves implanting a small device that delivers mild electrical pulses to the spinal cord, modulating pain signals and reducing the perception of pain.

HF10 differs from traditional SCS in that it uses high-frequency (10 kHz) stimulation, which has been shown to provide superior pain relief without the tingling sensation (paresthesia) associated with conventional SCS[7].

Indications for HF10 in Chronic Abdominal Pain

HF10 may be an appropriate treatment option for patients with chronic abdominal pain who have not found adequate relief with conservative treatments, such as medication, lifestyle modifications, or psychological therapies. Some specific conditions that may benefit from HF10 include:

  • Chronic Pancreatitis
  • Chronic Pelvic Pain Syndrome
  • Post-surgical Abdominal Pain
  • Abdominal Pain Associated with Spinal Cord Injury or Disease

Before considering HF10, patients typically undergo a trial period with a temporary stimulator to assess their response to the therapy. If the trial is successful, a permanent device can be implanted.

Benefits and Limitations of HF10

HF10 has several potential benefits for patients with chronic abdominal pain, including:

  • Significant pain reduction
  • Improved function and quality of life
  • Decreased reliance on pain medications
  • Long-lasting relief with a minimally invasive procedure

However, HF10 also has some limitations:

  • Not all patients respond to the therapy
  • Surgical risks, such as infection or device migration
  • Potential need for device adjustments or replacements over time
  • Limited coverage by some insurance plans

Patients should discuss the potential benefits and risks of HF10 with their healthcare provider to determine if it is an appropriate treatment option for their specific condition and circumstances. To learn more about HF10 for chronic pain management, visit our dedicated article on What is HF10 for Chronic Pain?.

Importance of a Multidisciplinary Approach

Managing constant abdominal pain often requires a multidisciplinary approach, involving collaboration among various healthcare professionals to provide comprehensive, patient-centered care. A multidisciplinary team may include:

  • Primary Care Physicians to coordinate overall care and provide ongoing management
  • Gastroenterologists to diagnose and treat gastrointestinal conditions
  • Pain Management Specialists to develop personalized pain management plans
  • Registered Dietitians to provide guidance on nutrition and dietary modifications
  • Mental Health Professionals to address the psychological impact of chronic pain
  • Physical Therapists to help patients maintain function and improve quality of life

By working together, a multidisciplinary team can develop a holistic treatment plan that addresses the physical, emotional, and social aspects of living with constant abdominal pain.

Conclusion

Constant abdominal pain is a complex and often challenging condition that can significantly impact a patient’s quality of life. As a medical professional, it is essential to provide patients with accurate, up-to-date information about the potential causes, diagnostic process, treatment options, and coping strategies for managing this condition.

By adopting a patient-centered, multidisciplinary approach to care, healthcare providers can help patients with constant abdominal pain achieve better symptom control, improved function, and enhanced overall well-being. Encouraging open communication, shared decision-making, and ongoing support can empower patients to take an active role in their care and work towards a better quality of life.

Key Takeaways

  1. Constant abdominal pain is a common and often debilitating condition that can be caused by various underlying gastrointestinal and non-gastrointestinal disorders.
  2. Diagnosing the cause of constant abdominal pain typically involves a combination of medical history, physical examination, laboratory tests, imaging studies, and endoscopic procedures.
  3. Treatment options for constant abdominal pain may include lifestyle modifications, dietary changes, medications, psychological therapies, complementary and alternative medicine, and, in some cases, surgical interventions.
  4. Coping strategies, such as keeping a symptom journal, practicing mindfulness and relaxation techniques, engaging in regular physical activity, joining a support group, and communicating with healthcare providers, can help patients better manage their symptoms and improve their quality of life.
  5. A multidisciplinary approach to care, involving collaboration among various healthcare professionals, is essential for providing comprehensive, patient-centered management of constant abdominal pain.

By staying informed, proactive, and engaged in their care, patients with constant abdominal pain can work with their healthcare team to find the most effective management strategies and achieve the best possible outcomes.

References

  1. Viniol, A., Keunecke, C., Biroga, T., Stadje, R., Dornieden, K., Bösner, S., … & Becker, A. (2014). Studies of the symptom abdominal pain—a systematic review and meta-analysis. Family Practice, 31(5), 517-529. DOI: 10.1093/fampra/cmu036
  2. Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: a clinical review. Jama, 313(9), 949-958. DOI: 10.1001/jama.2015.0954
  3. Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 6, 71. DOI: 10.2147/CLEP.S40245
  4. Ford, A. C., Lacy, B. E., & Talley, N. J. (2017). Irritable bowel syndrome. New England Journal of Medicine, 376(26), 2566-2578. DOI: 10.1056/NEJMra1607547
  5. Staudacher, H. M., & Whelan, K. (2017). The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut, 66(8), 1517-1527. DOI: 10.1136/gutjnl-2017-313750
  6. Sayed, G. E., Mehta, K., Saini, S., Widjaja, E., & Morley-Forster, P. K. (2021). The efficacy and safety of 10-kHz high-frequency spinal cord stimulation in the management of chronic painful diabetic neuropathy: Study protocol for a randomized controlled trial. Trials, 22(1), 1-7. DOI: 10.1186/s13063-021-05272-y
  7. Kapural, L., Yu, C., Doust, M. W., Gliner, B. E., Vallejo, R., Sitzman, B. T., … & Burgher, A. H. (2016). Comparison of 10-kHz high-frequency and traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: 24-month results from a multicenter, randomized, controlled pivotal trial. Neurosurgery, 79(5), 667-677. DOI: 10.1227/NEU.0000000000001418
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