Chronic functional abdominal pain (CFAP) is the ongoing presence of abdominal pain for which there is no known medical explanation. It is quite similar to, but less common than, irritable bowel syndrome (IBS), and many of the same treatments for IBS can also be of benefit to those with CFAP. The fundamental difference between IBS and CFAP is that in CFAP, unlike in IBS, there is no change in bowel habits such as constipation or diarrhea. Bowel dysfunction is a necessary diagnostic criterion of IBS.
CFAP is characterized by chronic pain, with no physical explanation or findings (no structural, infectious, or mechanical causes can be found). It is theorized that CFAP is a disorder of the nervous system where normal nociceptive nerve impulses are amplified "like a stereo system turned up too loud" resulting in pain. Alternately it is hypothesized that there exists in the intestine a protozoan (namely blastocystis) which is interacting with the sympathetic nervous system and causing the pain.
Newer semi-synthetic antibiotics such as rifaximin have been used in treatment. This visceral hypersensitivity may be a stand-alone cause of CFAP, or CFAP may result from the same type of brain-gut nervous system disorder that underlies IBS. As with IBS, low doses of antidepressants have been found useful in controlling the pain of CFAP.
Non-pharmaceutical approaches to CFAP also overlap with treatments for Irritable Bowel Syndrome. This includes enteric coated peppermint oil capsules, which act as anti-spasmodics to relax the gut and also have pain-killing properties due to the methyl salicylate that naturally occurs in peppermint.
Gut-directed hypnotherapy or self-hypnosis can also mitigate the hyperreactive nervous system of CFAP, and help alleviate abdominal pain
To demonstrate the correlation between CFAP and IBS we have included the below, which has been taken from the Cleveland Clinic website. While CFAP may be a different complaint to IBS, it is very common for IBS sufferers to endure chronic abdominal pain.
Sadly for many the difficulty in discovering the source of the pain, may lead to many appointments with a Gastro, before any progress is made. This condition in particular is one that is best lest to medical practitioners, although there may be things you can do if the problem is diet related. For example ‘Visceral Hypersensitivity’ is known to occur in many IBS sufferers and it may be that some sufferers reactions to certain foods lead to bloating and discomfort which is heightened by their sensitivity. In such cases diet can be the best way of treating the condition.
Irritable Bowel Syndrome and Possible Endometriosis
mw2000: I've had constant low-intensity abdominal pain for 12 years, caused by irritable bowel syndrome or possibly endometriosis. So far, I've been told to live with it, but it's waking me up at night, leaving me fatigued. Is there any hope for pain management?
Dr__Vrooman: I'm sorry to hear about this pain condition. Irritable bowel syndrome is a painful and aggravating condition. This may be quite amenable to treatment strategies advocated by our pain psychologist. These include relaxation strategies, biofeedback and other treatment options. Biofeedback is particularly interesting, and may be helpful for abdominal pain as well as chronic back pain or extremity pain. Some patients find that this and other pain conditions are disabling. Working with a pain psychologist or in an interdisciplinary rehabilitation program can sometimes be helpful, particularly for those patients who have become dependent upon opioid medications.
In regard to endometriosis, this may be treated surgically if indicated. Given that the pain may be visceral, a nerve block such as a superior hypogastric plexus block may be helpful for pain that has not responded to medications or other therapies.
Please note the educational material presented is for informational purposes only and is not intended to diagnose, treat, or cure any disease. Consult with your doctor prior to starting any supplement regimen or making any changes to your prescribed medications.
Firstly we are so sorry it can take so long to pick up your tweet, and realise that this may be too late for this particular flare up, however we hope that it helps in the future. Before proceeding we must also re-iterate that we this site is written by sufferers and is not medical advice, we always recommend getting medical advice first, in case any of the symptoms are more serious than they may appear.
If you are confident that it is IBS, then we recommend ‘Colloidail Silicic Acid’, which can rapidly reduce the symptoms you mentioned. There are other products around the world which are worth a try, however this would be our top choice.
Avoiding flare ups
In the long term we would always recommend that you consider looking at something like the Low FODMAP diet. It does not work for everyone, however it has excellent rates of success for IBS sufferers. We have all been really impressed by it, as it is a great natural and healthy way to deal with IBS. Here is a link to our Low FODMAP site www.ibssano.com
We would also recommend that you check out our ‘foods to avoid’ page as it is worth investigating what may be triggering your flare ups. When they occur it may be very difficult to stop, so it is worth really looking into the potential causes. Foods to avoid
You have our deepest sympathy on this matter, speaking personally, I used to have terrible flare ups, until I found a number of the trigger foods. Everything is great these days, however I recently received some bad news I ate and drank the things I shouldn’t and ended up in real pain, it reminded me that sacrificing a few foods was very much worth it.
Do consider checking out the possibility that you may have Colitis or similar . If that is the case you will need specific care and medication, so please be aware of that. Have put a link into page which list the symptoms as you will need the right care.