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2014 ; 107
(9
): 347-54
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Mechanisms and management of functional abdominal pain
#MMPMID25193056
Farmer AD
; Aziz Q
J R Soc Med
2014[Sep]; 107
(9
): 347-54
PMID25193056
show ga
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.