title: Centrally Mediated Disorders of Gastrointestinal Pain.
abstract: Centrally Mediated Abdominal Pain Syndrome (CAPS), formerly known as Functional Abdominal Pain Syndrome, can be distinguished from other functional GI disorders by its strong central component and relative independence from motility disturbances. CAPS is a result of central sensitization with disinhibition of pain signals rather than increased peripheral afferent excitability. A newly described condition, Narcotic Bowel Syndrome (NBS)/Opioid-Induced GI Hyperalgesia, is characterized by the paradoxical development of or increases in abdominal pain associated with continuous or increasing dosages of opioids. Patients only have relief when opioids are withdrawn. We define both conditions in the context of epidemiology, pathophysiology, clinical evaluation and treatment, emphasizing the importance of a physician-patient relationship in all aspects of care.
authors.affiliation: Division of Gastroenterology, Ichan School of Medicine at Mount Sinai, 17 East 102nd Street - 5th Floor, New York, NY 10029. Electronic address: drlauriekeefer@gmail.com.
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
authors.affiliation: Center for Functional GI and Motility Disorders, University of North Carolina and Center for Education and Practice of Biopsychosocial Care LLC, Drossman Gastroenterology PLLC, Chapel Hill NC USA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Drossman
authors.affiliation: Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester UK.
authors.forename: Elspeth
authors.initials: E
authors.lastname: Guthrie
authors.affiliation: Dept. of Internal Medicine & Clinical Nutrition, Institute of Medicine Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.affiliation: Oppenheimer Family Center for Neurobiology of Stress Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles CA USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Tillisch
authors.affiliation: SJHMC Internal Medicine Department, Phoenix AZ USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Olden
authors.affiliation: Education and Research Centre Wythenshawe Hospital, Manchester UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Whorwell
keywords: Centrally Mediated pain; Rome IV; chronic abdominal pain; functional abdominal pain; narcotic bowel