78-year-old woman, referred from the general surgery department to the pain clinic for chronic abdominal pain secondary to intestinal angina. No history of chronic degenerative diseases. She underwent 2 laparotomies in 6 months and 1 diagnostic laparoscopy for episodes of mesenteric ischaemia.
- Diagnosis: mesenteric ischaemia corroborated by computed tomography with venous and arterial contrast.
- Present illness: patient with chronic, generalised, severe abdominal pain, of 6 months' duration, which does not subside with the usual analgesics. Colicky pain, VAS 10/10, severe EVERA, disabling, episodic, sometimes accompanied by nausea and vomiting, with no factors that increase or decrease it.
- Physical examination: weight 45 kg; height 1.50 m; blood pressure 90/50 mmHg; heart rate 65; respiratory rate 18. Conscious, oriented, hydrated, with pallor of mucous membranes and integuments, cachectic. Face, head and neck without alterations, cardiopulmonary without compromise, abdomen with generalised pain in all quadrants, severe, on superficial and deep palpation, peristalsis present and of normal characteristics, without palpable masses. The rest of the physical examination was normal.
- Algaeological diagnosis: severe visceral chronic abdominal pain.
- Aetiological diagnosis: intestinal angina (mesenteric ischaemia).

Clinical course
Therapy with potent opioids (hydromorphone, methadone, oxycodone, morphine and transdermal fentanyl) and adjuvants, such as calcium antagonists, nitrates, etc., with different rotations and management schemes according to her clinical evolution. Not a candidate for intervention due to clinical status and anticoagulation with acenocoumarin, and due to the use of antiplatelet agents.