S1175 The Efficacy of Dicyclomine for the Unspecified Abdominal Pain (UAP) in the Emergency Department: A Retrospective Study

Introduction: Unspecified abdominal pain (UAP) refers to abdominal discomfort without an identifiable cause following initial evaluation. It is a common presentation in emergency departments (ED), where timely and effective pain management is crucial. This study examines the use of dicyclomine—a muscarinic (M1, M2, M3) receptor antagonist and non-competitive inhibitor of histamine and bradykinin, commonly used for intestinal spasms in functional bowel disorders and irritable bowel syndrome (IBS)—for early pain relief in patients with UAP in the ED setting. Methods: We conducted a retrospective chart review of ED visits from January 1, 2019, to November 1, 2024. Patients included were non-pregnant adults (age >18 years) with a first-time diagnosis of UAP (International Classification of Diseases-10 code R10.9), who received dicyclomine and had complete pre- and post-treatment pain scores along with demographic and clinical data. Out of 3,517 identified cases, 280 met inclusion criteria. Patients with incomplete records or identifiable organic causes were excluded. The primary outcome was the need for additional analgesia following dicyclomine administration. Results: The study included 280 patients with a median age of 40.7 ± 16.8 years; 55.7% were women. First-time ED presentation for UAP occurred in 57.1% (160), and 55.7% (156) had no known comorbidities. Dicyclomine was administered within 30 minutes of physician evaluation in 74.3% (208) of cases, and within 1 hour in 25.7% (72). Administration routes were oral in 13.9% (39) and intramuscular in 86.1% (241). The majority received a 20 mg dose (98.6%). Mean pain scores significantly decreased from 7.65 ± 1.57 to 2.45 ± 1.41 post-dicyclomine, with a mean reduction of 5.2 ± 1.77 (t = 49.1, df = 279, P < 0.001). Binary logistic regression identified female sex (OR = 5.97, P < 0.05) and delayed drug administration (>60 minutes) (OR = 10.3, P < 0.05) as significant predictors of requiring additional analgesia. Of the total, 66.1% (185) did not require additional analgesia, while 33.9% (95) did. Among these, 18.2% (51) received opioids, 9.6% (27) nonsteroidal anti-inflammatory drugs, and 6.1% (17) both. Overall, 99.6% (279) of patients were discharged home from the ED. Conclusion: Although evidence on the use of dicyclomine for UAP is limited, our findings suggest that it may be an effective initial analgesic option in the ED, particularly for younger patients without comorbidities. Prompt administration appears to improve outcomes and reduce the need for additional analgesics, especially opioids.