gastrointestinal disorders
Chronic Abdominal Pain and Recurrent Abdominal Pain
Treatment
Physiologic conditions are treated. If the diagnosis of functional CAP is made, frequent examinations and tests should be avoided because they may focus on or magnify the physical complaints or imply that the physician lacks confidence in the diagnosis. There are no modalities to cure functional CAP; however, many helpful measures are available. These measures rest on a foundation of a trusting, empathic relationship between the physician, patient, and family. Patients should be reassured that they are not in danger; specific concerns should be sought and addressed. The physician should explain the laboratory findings and the nature of the problem and describe how the pain is generated and how the patient perceives it (ie, there may be a tendency to feel pain at times of stress). It is important to avoid perpetuating the negative psychosocial consequences of chronic pain (eg, prolonged absences from school or work, withdrawal from social activities) and to promote independence, social participation, and self-reliance. These strategies help the patient control or tolerate the symptoms while participating fully in everyday activities. Drugs such as antispasmotics and tricyclic antidepressants can be effective. Opioids should be avoided because of the concern about potential dependency and possibility of narcotic bowel syndrome. Dietary modification and consumption of high-fiber foods or fiber supplements may help some patients. Evidence supporting the use of probiotics for centrally mediated abdominal pain syndrome is currently limited. (See the American College of Gastroenterology's2021 clinical guideline for the management of IBS.) Cognitive methods (eg, relaxation training, biofeedback, hypnosis) may help by contributing to the patient’s sense of well-being and control. Regular follow-up visits should be scheduled weekly, monthly, or bimonthly, depending on the patient’s needs, and should continue until well after the problem has resolved. Psychiatric referral may be required if symptoms persist, especially if the patient is depressed or there are significant psychologic stressors at home. 