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December 9, 1988

Rectal Pain

Author Affiliations

Walnut Creek, Calif

Walnut Creek, Calif

JAMA. 1988;260(22):3276-3277. doi:10.1001/jama.1988.03410220060019

To the Editor. —  In the June 17 issue of THE Journal1,2 there was a question regarding persistent undiagnosed rectal pain. Several possible diagnoses were excluded from the answers of the various specialists.Rarely, central pain mechanisms or strictly psychological mechanisms can cause persistent undiagnosed pain. In our practice, however, previously undiagnosed pain is more commonly found to be a sympathetic mediated pain syndrome or to result from degenerative disk disease or both.

Report of Cases.—  Case 1.—A 60-year-old woman had a sudden onset of right lower quadrant pain one year before our evaluation. Extensive evaluations, including two exploratory laparotomies without improvement, resulted in referral to us.Abdominal examination revealed tenderness near her appendectomy scar, with no guarding but with moderate rebound discomfort.A diagnostic epidural block was performed and the patient had complete relief of her symptoms following a sympathetic nerve block. After a series of five sympathetic