Treatment options for functional abdominal pain.

The successful treatment of pediatric FBD begins during the initial interaction among the patient, family, and physician. It is important that the physician establish a trusting relationship with the family. An early introduction of the concept of functional pain in the differential diagnosis avoids later problems convincing the family that further diagnostic testing is unnecessary. If diagnostic testing is warranted to exclude an organic disorder, it is useful to explain that these tests are being performed to rule out disorders that can present similarly to FBD. Thus, the patient and family recognize that the most likely diagnosis is FBD, and treatment can begin following negative testing. Physicians must account for the role of psychosocial and medical factors that contribute to the expression of illness so as to optimize diagnosis and care. Exploration into the child's psychosocial history can identify a comorbid condition such as anxiety or depression and help guide, specific therapy with psychological interventions, medication, or both. In cases where the abdominal pain is affecting the child's activities of daily living, such as school performance, referral to a psychologist skilled in the use of techniques such as cognitive behavioral therapy may be useful. Symptom-directed pharmacologic therapy can be useful in selected cases.