Functional abdominal cramping pain: practical guidance by expert panel
Germany: A panel of experts on functional gastrointestinal disorders has released a practical guideline on the causes, diagnosis, and management of functional abdominal cramping pain.
"Functional abdominal cramping pain (FACP) is a regular complaint, that may either present on its own or in association with a functional gastrointestinal disorder," the document published in the Journal of Clinical Gastroenterology stated. "It is likely caused by a variety of, probably partly unknown, etiologies."
The authors further added that FACP's effective management can be challenging due to the dearth of usable diagnostic tools and the availability of a diverse range of treatment approaches. Practical guidance for their selection and use is limited. The guideline was developed with the objective to present a working definition of FACP based on expert consensus and proposing practical strategies for the diagnosis and management of this condition for physicians, pharmacists, and patients.
Statements and Recommendations are given below
Burden of FACP
- Health care professionals, including primary care physicians/general practitioners, specialists, and pharmacists, should be aware of FACP, the impact it can have on sufferers, and the management of symptoms.
Causes of FACP
- The causes of FACP in functional gastrointestinal disorders (FGID) are unclear but are probably multifactorial.
Diagnosis and Investigation of FACP in Primary Care
· The first step for evaluating FACP in primary care is to rule out "red flags" (alarm signals) of structural organic disease, which necessitate referral to a specialist.
· A detailed evaluation of family history, characteristics of pain, medication, and eating/bowel habits should be undertaken in all patients presenting to primary care with FACP symptoms.
· A physical examination (including bowel sounds and digital rectal examination), psychosocial assessment, and laboratory tests may also be appropriate in selected cases and at the discretion of the doctor. Abdominal ultrasound investigations may be helpful.
Clinical Management of FACP in Primary Care
• Mild, infrequent episodes of FACP may only require reassurance and advice (including avoidance of trigger foods), whereas more intensive and/or frequent episodes usually require therapeutic intervention.
• Many patients with FACP who present to primary care may require empirical treatment with an antispasmodic, the choice of which will depend on local availability and individual preference. If the first drug does not provide adequate symptom relief, it might be worthwhile to try an alternative antispasmodic.
• Patients who obtain little or no relief from their FACP with an antispasmodic may benefit from additional analgesia, for example, with acetaminophen (paracetamol).
• Patients with centrally mediated abdominal pain syndrome may respond to low doses of tricyclic antidepressants or selective serotonin reuptake inhibitors, or to the neuromodulator pregabalin.
• Relaxation training and targeted psychological interventions may be helpful adjunctive therapies for selected patients who suffer from stress and/or have preexisting psychiatric comorbidities.
Self-management of FACP
• Self-management of FACP using over-the-counter products is appropriate for many patients with mild, nonpersistent symptoms.
• To enable better self-care, patients and pharmacists require education and information on signs and symptoms to be aware of, and which treatments to use.
Reference:
Müller-Lissner, Stefan MD*; Andresen, Viola MD†; Corsetti, Maura MD, PhD‡,§; Bustos Fernández, Luis MD∥; Forestier, Sylvie MD¶; Pace, Fabio MD, PhD#; Valdovinos, Miguel A. MD**. Functional Abdominal Cramping Pain: Expert Practical Guidance. Journal of Clinical Gastroenterology: September 23, 2022 - Volume - Issue - 10.1097/MCG.0000000000001764 doi: 10.1097/MCG.0000000000001764
