Chronic Functional Abdominal Pain (CFAP) Causes, Symptoms, Diagnosis, Treatment

Chronic Functional Abdominal Pain (CFAP) Causes, Symptoms, Diagnosis, Treatment

Definition of Chronic Functional Abdominal Pain (CFAP)

Chronic functional abdominal pain is a type of pain that is mostly constant for at least three months. It is caused by a change in the nervous system related to stress. Scientists have confirmed a direct connection between the brain and the nerves of the stomach and intestines to explain this very real and often severe pain.

Chronic and recurrent abdominal pain is a common problem for children and adolescents. It occurs in 9 to 15% of all children. In most cases, abdominal pain is not serious and will improve on its own.

Causes of Chronic Functional Abdominal Pain

No one knows for sure what causes chronic abdominal pain, but it is considered a disorder of the nervous system in which nerve impulses are increased, resulting in pain. This disorder is closely linked with emotional issues and the nervous system. An individual experiencing chronic functional abdominal pain feels all movements in the abdomen as a painful, unpleasant sensation, as nerves are amplified.

Recent stressful events, such as death in the family, divorce, a move, or unemployment, can contribute. In addition, there are other mainly psychological disorders that have been shown to have a high correlation with this condition.

Other Diseases Linked to Chronic Functional Abdominal Pain

Chronic abdominal pain is one of the main symptoms of depression, and the two are often closely linked. This makes psychiatric treatment or general stress reduction important, to address these causes.

Symptoms of Chronic Functional Abdominal Pain

The patient with chronic functional abdominal pain will usually have had the pain for a very long time. The pain is often a dull achy type rather than sharp or severe enough to go to the hospital emergency room. Often, there will have been multiple previous abdominal surgeries. For reasons unknown, the patient is often a female. There is a surprising incidence of physical or sexual abuse in childhood in these patients. Features such as weight loss, fever or rectal bleeding are not present.

Chronic functional abdominal pain occurs when signals from your gut reach the brain indicating that something is wrong. Because chronic functional abdominal pain is not associated with food or defecation, it distinguishes itself from the other gastrointestinal disorders such as irritable bowel syndrome or dyspepsia. The pain is real which can make the problem very frustrating for the patient and physician alike, because there are no tests to confirm what is going on. The real problem is within the wiring of the gut and its connection to the brain.

Risk Factors of Chronic Functional Abdominal Pain

While abdominal pain can occur without cause, it can also happen after a stressful event like the death of a loved one, a divorce or abuse. After the first event, during times of added stress, symptoms can worsen. Injury, such as surgery, can also cause nerves in the abdomen to become so sensitive that even normal abdominal activity may be painful.

How is chronic functional abdominal pain diagnosed?

Evaluation of chronic abdominal pain typically begins by ruling out common gastrointestinal organic causes such as peptic ulcer disease, gastroesophageal reflux disease, biliary colic, cancer, etc. 

Then, some criteria to diagnose chronic functional abdominal pain should be followed. These criteria include:

  • 6 months at least of continuous or almost continuous abdominal pain.
  • The abdominal pain is hardly or not related to physiological events (ingestion, defecation, menstruation).
  • It interferes with everyday activities.

Treatment for Chronic Functional Abdominal Pain

The goal of treatment for  Chronic Functional Abdominal Pain is to gain control of symptoms and to improve the quality of daily life. It is usually not possible to eliminate the pain altogether. However, the treatment plan, hopefully, can control the discomfort enough to allow a better quality of life. Treatment is usually divided into two parts.

The mind-body connection

It sometimes is helpful to keep a diary to record symptom flare-ups and especially, any triggers such as emotional or situational stress.

Stress management. There are certain stress management techniques such as meditation that can be helpful.

Hypnosis. This is an old form of therapy that may he useful in some instances to refocus thoughts away from pain and to teach the patient to react or think differently.

Behavioral Therapy. A patient can change thoughts, perceptions and behavior using proven techniques.

Discuss these treatment options with the physician. At times, a counselor or psychologist may be helpful.

Medications for Chronic Functional Abdominal Pain

Certain anti-depressant medications can help stimulate the brain to increase certain nerve signals which are sent down to the control center at the base of the brain, These signals may act to block the pain nerve impulses which are being sent up from the abdomen. Some people don’t want to take these medications because they say they are not depressed. It is important to note that depression is not the reason the medicine is given. Rather it is to stimulate the brain in the manner mentioned

One category of medications is the tricycle antidepressants such as Elavil (amitryptyline) or Desyrel (trazodone). These drugs often take several weeks to reach theirs full effect so persistence and patience is necessary. There may be some initial drowsiness, but this generally leaves after several days. Other side effects include dry mouth and constipation.

Another Category of drugs is called selective serotonin reuptake inhibitors (SSRI). These include Prozac, Paxil, Zoloft and others. They occasionally can cause sleep disturbances, restlessness and diarrhea. These side effects are often temporary and the medicines should be taken until the full effect is known.

Self Care

The first step in self-care is to understand the nature of your symptoms. Using a journal to keep track of your bowel movements, pain symptoms and feelings during the day can help you assess your patterns and pain triggers. Be sure to bring your journal whenever you see your physician.

Ask yourself what you do in your daily life to relax. It is helpful to have a few ways to relax and/or distract yourself from the pain. Some people like to exercise, others like to read or watch TV, and still others like to do mind-body techniques like yoga, meditation, tai chi or massage. Some people feel better talking to people about their feelings. If you are in this group, ask family and friends to listen to you, or join a support group to talk about your feelings related to your chronic pain.

When to Call Your Doctor

If you suffer from chronic functional abdominal pain, you should contact your provider immediately if you develop fever, bloody stools, diarrhea, vomiting, pain that is more severe and lasts more than one hour, or pain that is intermittent and lasts greater than 24 hours because that means something else is going on.

Chronic functional abdominal pain can be a distressing and frustrating disorder for the patient. The important thing to remember is that testing usually reveals no underlying disorder and that surgery is not helpful.