Case Study | Eight Years of Left Upper Abdominal Pain — Looking Beyond the Abdomen

This patient was a 55-year-old European man who had experienced left upper abdominal pain for approximately eight years.

Most of the time, he described a persistent dull ache. In addition, two or three times a day, he would develop episodes of sharper pain that could last for one to two hours.

When the pain became severe, he often had to stop what he was doing, lie down and take pain medication.

Over the years, he had seen multiple specialists and undergone extensive investigations, but no clear abnormality had been found to explain the pain.

The problem had continued to interfere with both his work and daily life.

Eventually, a Chinese colleague suggested that he come to see me.

Clinical Examination

On examination, there was no obvious sensory loss or hypersensitivity over the left upper abdomen.

However, when I examined the thoracic spine and back, I found marked muscle tightness and tenderness around the left T7, T8 and T9 paraspinal region.

This finding made me reconsider the source of the pain.

Although the patient felt the symptoms in the upper abdomen, the problem might not necessarily have been coming from an abdominal organ.

I began to consider whether the thoracic spine, intercostal nerve pathway, or related chest wall structures could be contributing to the pain.

From a traditional Chinese medicine perspective, the long duration of the pain was also considered consistent with a chronic stagnation pattern.

Treatment

Treatment was directed mainly at the thoracic paraspinal region.

I used mini needle-knife treatment around the relevant back-shu and paraspinal areas, together with cupping.

After the first two treatments, the patient did not notice much change.

By the third treatment, however, both the intensity and frequency of the sharp pain had clearly reduced.

He estimated that the problem was about 50% better.

Another important change was that when the pain did occur, he no longer felt the need to take pain medication.

Treatment continued.

After eight sessions, the patient reported that the pain was almost completely gone.

Six-Month Follow-Up

Approximately six months later, I received a message from the patient.

He told me that the pain had completely disappeared.

For a patient who had lived with the problem for eight years, this long-term follow-up made the case especially meaningful.

Clinical Reflection

Upper abdominal pain naturally raises concern about internal organs.

Right-sided pain may lead us to think about the liver or gallbladder. Left-sided pain may raise questions about the stomach, pancreas, spleen, heart or other internal structures.

These possibilities must be considered and, when appropriate, investigated.

But when a patient has already undergone substantial medical assessment and the results do not explain the ongoing symptoms, the clinical examination should not stop there.

The thoracic spine, intercostal nerves, chest wall muscles and surrounding soft tissues can also refer pain toward the chest or upper abdomen.

In this case, there was no clear abdominal sensory abnormality, so I could not diagnose intercostal neuralgia simply from the symptom location alone.

The more useful clue was the marked tenderness and tightness around the left T7–T9 thoracic region.

That finding changed the direction of my assessment and treatment.

The lesson from this case is not that chronic upper abdominal pain is always caused by the thoracic spine.

It is that when the existing diagnosis or investigations do not adequately explain the patient’s symptoms, we need to continue looking for other clinical clues.

Sometimes the place where the patient feels the pain is not the place where the problem begins.

Published on: Nov 12, 2018 at 17:40
Revised for Website 2.0: 14 November 2026

Disclaimer:
This case study reflects one individual patient’s history, examination findings and response to treatment. Left upper abdominal pain may arise from gastrointestinal, cardiac, pancreatic, splenic, pulmonary, musculoskeletal or neurological causes. Persistent or severe abdominal pain should receive appropriate medical assessment before a musculoskeletal or nerve-related source is considered.

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If persistent chest or abdominal pain has already been medically investigated but the symptoms remain unexplained, a broader clinical assessment of the thoracic spine, chest wall, muscles and nerve pathways may identify additional contributing factors.

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