Chronic functional abdominal pain

Overview

Chronic Functional Abdominal Pain (CFAP) is a condition characterized by long-lasting or recurrent abdominal pain that cannot be explained by any identifiable structural or biochemical abnormality. Unlike irritable bowel syndrome (IBS), which is associated with changes in bowel habits, CFAP occurs independently of eating, digestion, or bowel movements. It is classified as a functional gastrointestinal disorder and is most commonly seen in children and adolescents, but it can also affect adults. The pain in CFAP can be severe and disabling, significantly impacting daily activities and quality of life.

Causes

The exact cause of chronic functional abdominal pain is not well understood, but it is believed to be related to how the brain and gut communicate. Factors that may contribute include:

• Visceral hypersensitivity: Increased sensitivity to normal sensations in the gastrointestinal tract

• Stress and psychological factors: Anxiety, depression, or past trauma can influence pain perception

• Altered brain-gut axis: Disruptions in the neural pathways that connect the brain and digestive system

• Genetic predisposition: A family history of functional gastrointestinal disorders

• Previous infections or inflammation: May trigger persistent pain despite resolution of the original issue

Symptoms

The hallmark symptom of CFAP is persistent abdominal pain without a clear physical cause. Key characteristics include:

• Continuous or frequently recurring abdominal pain

• Pain not related to meals or bowel movements

• Pain that interferes with daily life, such as school, work, or sleep

• No significant findings on lab tests or imaging studies

• May coexist with other symptoms: Fatigue, headache, or general malaise

• Often worsens with stress or emotional distress

Diagnosis

Diagnosing CFAP is based on clinical history and the exclusion of other medical conditions. The diagnostic process typically involves:

• Detailed medical history: Including symptom patterns, triggers, and psychosocial factors

• Physical examination: To rule out organic causes of abdominal pain

• Basic lab tests: Such as blood work, urinalysis, and stool studies

• Imaging: Abdominal ultrasound or X-ray may be performed to exclude structural abnormalities

• Rome IV criteria: Used to define functional gastrointestinal disorders, including CFAP

• Psychological evaluation: May be suggested if anxiety, depression, or trauma are suspected contributors

Treatment

Treatment for CFAP focuses on symptom relief and improving quality of life through a multidisciplinary approach. Key treatment strategies include:

• Psychological therapy: Cognitive behavioral therapy (CBT) is effective in reducing pain and coping with stress

• Medications:

  • Low-dose antidepressants (e.g., amitriptyline) to reduce pain perception

  • Antispasmodics or mild pain relievers as needed

• Stress management: Relaxation techniques, mindfulness, and biofeedback can help manage emotional triggers

• Dietary modifications: Although CFAP is not related to food, some patients may benefit from a trial elimination of potential irritants (e.g., lactose, gluten)

• Education and reassurance: Helping patients and families understand that the pain is real but not due to a dangerous illness

• Regular physical activity: To promote overall health and reduce stress

Prognosis

The prognosis for Chronic Functional Abdominal Pain varies. While some individuals improve with treatment and time, others may continue to experience chronic symptoms. Early intervention, especially with behavioral therapy and stress management, greatly improves outcomes. Most children with CFAP eventually outgrow the condition, though they may remain at risk for other functional pain syndromes or mood disorders in adulthood. Ongoing support from healthcare providers, family, and school personnel is crucial for long-term success.