Chronic functional abdominal pain

Functional abdominal pain syndrome (FAPS) is a less common functional gastrointestinal disorder characterized by abdominal pain which is not related to food intake and defecation. It accounts for signifi cant health care impact and has a high co - morbidity with psychiatric disorders. Its etiology is incompletely understood, however, it relates primarily to dysfunction of central pain modulatory systems. The diagnosis of FAPS is primarily based on positive symptom criteria defi ned by Rome III; in the absence of alarm symptoms an extensive work - up is not required. Medical evaluation must include a careful physical examination, psychosocial assessment, and a cost - effective approach to rule out an alternative or co - existing diagnosis. Effective treatment approaches hinge on the principles of biopsychosocial medicine with emphasis on the doctor - patient relationship and negotiating reasonable treatment goals. These include the use of centrally acting pharmacological and psychological therapies that focus more on adaptive coping rather than complete cure. Antidepressants (tricyclic, selective serotonin reuptake inhibitors) are the mainstay of pharmacotherapy which also aims to target associated psychiatric co - morbidities. A multidisciplinary pain clinic approach and combination therapies are often helpful at the severe, refractory end of the spectrum of FAPS.