Functional abdominal pain syndrome.

Functional abdominal pain syndrome (FAPS) is one of the less common functional gastrointestinal disorders, yet it is one with high health care impact. It is best understood from a biopsychosocial perspective as the interaction of biologic and psychosocial factors contributing to symptom experience and behavior. The pain of FAPS relates primarily to dysfunction of central pain modulatory systems; however, disturbances in motility or visceral hypersensitivity may contribute. There are characteristic clinical and behavioral features that typify patients with FAPS, and the medical evaluation must include their recognition through psychosocial assessment, physical examination, and a conservative, cost-effective effort to exclude other diseases. The treatment approach depends on establishing an effective physician-patient relationship, setting reasonable treatment goals, and using multicomponent medical and behavioral strategies that are individualized to patient needs. In refractory cases, referral to a multidisciplinary pain treatment center might be helpful.