title: Mechanisms and management of functional abdominal pain.
abstract: Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain.
authors.affiliation: Centre for Digestive Diseases, Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London E1 2AJ, UK a.farmer@qmul.ac.uk.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Farmer
authors.affiliation: Centre for Digestive Diseases, Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London E1 2AJ, UK.
authors.forename: Qasim
authors.initials: Q
authors.lastname: Aziz
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D013116:Spinal Cord / Q000503:physiopathology*; D013127:Spinal Nerves / Q000503:physiopathology*; D013577:Syndrome
keywords: functional abdominal pain; investigation; management; pathophysiology