title: Centrally Targeted Pharmacotherapy for Chronic Abdominal Pain: Understanding and Management.
abstract: Chronic abdominal pain has a widespread impact on the individual and the society. Identifying and explaining mechanisms of importance for the pain experience within a biopsychosocial context are central in order to select treatment that has a chance for symptom reduction. With current knowledge of brain-gut interactions, chronic abdominal pain, which mostly appears in functional gastrointestinal disorders, to a large extent involves pain mechanisms residing within the brain. As such, the use of centrally targeted pharmacotherapy as an effective treatment option is obvious in a selected number of patients. The antidepressants are most common, but also other classes of medications can be used, either alone or in combination. The latter option refers to when there is insufficient effect of one drug alone or side effects limiting dosage, and when combined in lower doses, certain drugs give rise to augmentation effects. This chapter outlines basic mechanisms of importance for the understanding of chronic abdominal pain and the pharmacologic treatment options.
authors.affiliation: Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-41345, Gothenburg, Sweden. hans.tornblom@gu.se.
authors.forename: Hans
authors.initials: H
authors.lastname: Törnblom
authors.affiliation: Drossman Center for the Education and Practice of Biopsychosocial Care, Professor Emeritus of Medicine and Psychiatry, UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Drossman Gastroenterology PLLC, Chapel Hill, NC, USA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Drossman
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D000700:Analgesics / Q000627:therapeutic use*; D000818:Animals; D001921:Brain / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D059350:Chronic Pain / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D017615:Enteric Nervous System / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D041981:Gastrointestinal Tract / Q000294:innervation*; D006801:Humans; D058748:Pain Perception / Q000187:drug effects; D017288:Pain Threshold / Q000187:drug effects; D015398:Signal Transduction / Q000187:drug effects
chemical_list: D000700:Analgesics
keywords: Abdominal pain; Antidepressants; Brain–gut axis; Functional gastrointestinal disorders; Treatment