Functional abdominal pain syndrome (FAPS) differs
from the other functional bowel disorders; it is less
common, symptoms largely are unrelated to food intake
and defecation, and it has higher comorbidity with psychiatric
disorders. The etiology and pathophysiology are
incompletely understood. Because FAPS likely represents
a heterogenous group of disorders, peripheral neuropathic
pain mechanisms, alterations in endogenous
pain modulation systems, or both may be involved in
any one patient. The diagnosis of FAPS is made on the
basis of positive symptom criteria and a longstanding
history of symptoms; in the absence of alarm symptoms,
an extensive diagnostic evaluation is not required.
Management is based on a therapeutic physician-patient
relationship and empirical treatment algorithms
using various classes of centrally acting drugs, including
antidepressants and anticonvulsants. The choice, dose,
and combination of drugs are influenced by psychiatric
comorbidities. Psychological treatment options include
psychotherapy, relaxation techniques, and hypnosis. Refractory
FAPS patients may benefit from a multidisciplinary
pain clinic approach.
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