title: Centrally targeted pharmacotherapy for chronic abdominal pain.
abstract: BACKGROUND
  Chronic abdominal pain in the context of the functional gastrointestinal disorders departs from a more traditional approach to treating gastrointestinal symptoms. Chronic abdominal pain involves a dysregulation of brain-gut modulation of afferent signaling, so treatments directed toward the gut are not usually sufficient to achieve a clinical response. Rather the methods of treatment depend on re-establishing central pain regulation.
  
  
  OBJECTIVE
  A conceptual model of predisposing, precipitating, and perpetuating factors is used to explain how a situation of chronic pain develops and it provides the evidence for central neuron degeneration as relevant to this chain of events. The rationale for centrally targeted medications, in particular antidepressants, is discussed with regard to effects independent of their role in treating psychiatric disorders: with regard to downregulation of afferent pain signals and their potential role in neuron proliferation. Finally, guiding examples of which drug to use and treatment combinations involving multiple drugs, augmentation treatment, are outlined and some brief clinical cases of centrally targeted pharmacotherapy.
authors: Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: H
authors: H
authors: Törnblom
authors: D A
authors: DA
authors: Drossman
mesh_terms: D015746:Abdominal Pain / Q000150:complications / Q000188:drug therapy*; D000818:Animals; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy*; D005767:Gastrointestinal Diseases / Q000150:complications / Q000188:drug therapy*; D006801:Humans
chemical_list: D000928:Antidepressive Agents
keywords: abdominal pain; antidepressants; brain-gut axis; functional gastrointestinal disorders; treatment