Functional Abdominal Pain

Abstract

The centrally mediated disorders of gastrointestinal pain including centrally mediated abdominal pain syndrome (CAPS) are distinguished from other functional gastrointestinal disorders (FGIDs), now termed disorders of gut-brain interaction (DGBIs), by the greater contribution of the central nervous system (CNS) in producing pain symptoms relative to the contribution of gut motility disorders that may cause pain. While these disorders are less common than other DGBIs such as irritable bowel syndrome (IBS) or functional dyspepsia (FD), their impact on quality of life is significant. Older adults present as a unique population vulnerable to DGBIs and CAPS, whose pain symptoms and management should be approached somewhat differently compared to their younger cohort. The approach to elderly patients with chronic abdominal pain should focus on a thorough history and physical exam, looking for “alarm” features or “red flag” symptoms. Evaluations should be limited to those which might help provide an alternate explanation for these “alarm” features, if they are present. Diagnostic failures in disorders of centrally mediated abdominal pain are rare due to the relatively benign but protracted course of chronic pain conditions; the likelihood of morbid conditions presenting with such an extended course of pain is exceedingly low, once evaluation for “red flag” symptoms is complete. Treatment then focuses on pain modulation using centrally acting neuromodulators, either alone or in combination with psychotherapy such as cognitive behavioral therapy (CBT), mindfulness-based strategies, or hypnotherapy. Most importantly, older adults benefit from entering a therapeutic partnership with their provider to achieve improvement of symptoms by recognizing CAPS as the unifying diagnosis.