What is functional abdominal pain?

Related links:

• Our services: Caring for children with functional abdominal pain

Related tests and treatments:

• Manometry
• Auricular Neurostimulation
• Cognitive behavioral therapy
• Biofeedback

About functional abdominal pain

Functional abdominal pain originates from an abnormal connection between the nervous system in the intestines and the brain. There is an abnormality in how signals from the gastrointestinal tract are processed in the brain. There is no test that can specifically make the diagnosis. It is seen in several functional abdominal pain conditions, including abdominal migraines, irritable bowel syndrome and some autonomic disorders.

What causes functional abdominal pain?

Researchers still don’t know exactly what causes functional abdominal pain, but they know the problem is related to how the brain and gut interact together. This is why the term “disorders of the gut-brain interaction” is now used for conditions that include functional abdominal pain NOS, irritable bowel syndrome (IBS), functional dyspepsia, and abdominal migraine. Just like some patients suffer from headaches that result from stress or other causes, some children suffer from abdominal pain.

How often does functional abdominal pain occur?

Although the exact prevalence of this condition is unknown, it’s believed that as many as 25 percent of children in the community have abdominal pain that occurs at least once per week. Functional abdominal pain is one of the most common conditions in children, accounting for 4 percent of all general pediatric doctor visits.

How does functional abdominal pain develop?

We don’t yet know what causes this condition, but it is not uncommon to see it after a gastrointestinal infection or periods of stress.While it is not caused by anxiety, it can definitely contribute to make symptoms worse.

What are the symptoms of functional abdominal pain?

Although belly pain is the major symptom, functional abdominal pain can be associated with other symptoms, including:

• Nausea
• Constipation
• Diarrhea
• Vomiting
• Anxiety
• Fatigue

Who is at risk of developing this condition?

We don’t know, though researchers believe that stress and anxiety may play a role in some — but not all — cases. Family history may also be a factor in some cases. Infections in the gastrointestinal tract with bacteria or viruses also can cause chronic abdominal pain, long after the infection has passed.

Why is functional abdominal pain a concern?

For some children, the pain can be so frequent or intense that it can prevent them from participating in normal activities or attending school. If not addressed early, it can lead to pain-associated disability, a condition in which the pain is so severe and frequent that it interferes with the child’s daily life and activities. It can negatively impact a child’s quality of life.

How is functional abdominal pain diagnosed/evaluated?

There’s not a test to determine functional abdominal pain, so your doctor will usually make a diagnosis by eliminating other potential causes. Patients with functional abdominal pain usually won’t have any alarming symptoms, such as blood in the stool, fever or poor growth, which would point to another problem. Routine tests might also appear normal and reassure you that the diagnosis is correct. A GI specialist can help determine whether a patient’s pain is functional or due to another underlying gastrointestinal issue.

What is the treatment for functional abdominal pain?

Treatment depends on the severity of the disorder. Some kids could have only 5 minutes of pain a few times a week while others have severe, disabling pain that occurs daily. A more conservative treatment without medication may be appropriate for children with milder pain. Other children may benefit from pain medication, auricular neurostimulation or behavioral modifications.

Auricular Neurostimulation or Percutaneous Electrical Nerve Field Stimulation (PENFS) is a novel technique that uses electrical stimulation of small nerve fibers in the ear to access pain pathways in the brain. It is the only FDA approved/cleared treatment for children with functional abdominal pain. Children’s Wisconsin has been identified as a Neurostimulation “Center of Excellence” and currently one of a few centers in the country offering this treatment.

Biofeedback has been shown to be effective for children with functional abdominal pain. As the patient receives real-time physiological feedback from sensors connected to a computer, he or she learns how to control his or her physical responses. In the case of functional abdominal pain, biofeedback retrains the brain on how to perceive sensation coming from gut by changing how the patient breathes and thinks in response to pain. Cognitive behavior therapy can also be helpful by teaching both parents and the child coping strategies and how to dissociate from the pain.

Doctors may also prescribe natural treatments or diet modifications with proven benefits for less severe pain..

What happens after treatment?

The doctor will reevaluate your child after treatment. If the initial treatment was not effective, the doctor might try a new treatment. Pharmacological treatment could be prescribed for six months to a year depending on the severity of pain. Auricular neurostimulation is done as an outpatient over the course of 4 weeks and can lead to improvement of abdominal pain for many months and in some cases, completely resolve the abdominal pain. If the treatment is effective and the pain resolves, then the patient no longer requires a GI specialist’s care unless the pain reoccurs or new symptoms develop.

When should you contact a physician?

If your child complains of frequent belly pain, consult your pediatrician. Your child’s regular doctor will refer you to a GI specialist if necessary.

What is the long-term outlook for functional abdominal pain?

It’s believed that about 55-60 percent of patients will get better and do well long-term, but for others, chronic abdominal pain can linger or return. Early treatment is important to prevent the development of long-term symptoms. Investigators are closer to finding a cause and better ways to make the diagnosis.

How do I live with functional abdominal pain?

Functional pain is real pain and “not in a child’s head” as people used to think. Unfortunately, not all children have complete resolution of pain. Sometimes, limiting the pain so that the child can function is an initial strategy. Functional pain is not relieved by “positive thinking,” but it does help to retrain the brain. This sometimes requires the help of a mental health professional. Psychological treatments such as cognitive behavioral therapy and biofeedback can be very effective in managing day-to-day pain. Ask your child’s doctor about these options and encourage your child to practice the techniques whenever necessary.

For more information about this condition, visit kidstomachpain.com and the International Foundation for Functional Gastrointestinal Disorders.