Chronic Abdominal Pain: Practical Approaches

Chronic abdominal pain is a common presentation, and yet clinicians and patients often struggle with a suitable diagnostic label (naming the pain); how to avoid implying symptoms are all in the mind (framing the pain); how to avoid medical iatrogenesis for which patients are at risk (aggravating the pain) and finally what might be helpful rather than harmful in chronic pain rehabilitation (calming the pain). This article will review a diagnostic algorithm for the most appropriate name for the chronic pain; the importance of brain-gut axis and biopsychosocial framing of the pain; avoiding iatrogenic surgery and opioids that aggravate the pain and lastly the judicious use of gut-brain neuromodulators and psychotherapies to help with calming the pain. Future directions for research are highlighted. Despite the high clinical significance and prevalence of chronic abdominal pain presentations across both primary and secondary care, its diagnosis and management are marked by a general lack of confidence and unmet training needs, which this review attempts to address.