Q: My 24 years old wife is suffering from pain in the abdomen. She underwent an X-ray, ultrasound, endoscopy and CT-scan of her abdomen but all these reports came normal. They are terming it as functional pain. The pain started a month back but it stopped after we stayed in the hospital for two nights. The doctors gave her painkillers and antibiotics. But the pain recurred after 15 days. This time it was more severe and she became unconscious with pain and was again readmitted to the hospital for 5 days. She was fine for another 10-12 days and now the pain has started again four days back, but this time it is bearable. The doctor found some erosion inside her stomach on endoscopy. She was given these medicines – Clonotril - 0.5, Razo 20 and Paracetamol (650 mg). Normally the pain starts in the abdomen then spreads to back as well. She is having her periods regularly but they are usually painful. Four days back, when pain started, her menses had started. But now the bleeding has stopped but not the pain.

A:I would recommend a CT enterography to rule out any small bowel pathology, a Meckel’s scan and a urine porphyria screen in the first place before the pain can be labelled functional. Also, a trial of treatment with Mebeverine 135mg TID for 4 weeks will tell whether the pain is functional or not.