From the Guidelines
Treatment for trauma-related functional abdominal pain should involve a multidisciplinary approach, including psychological interventions and medication, with a focus on cognitive behavioral therapy (CBT) and low-dose tricyclic antidepressants, as recommended by the most recent guidelines 1.
Key Components of Treatment
- Cognitive behavioral therapy (CBT) is highly effective, with 8-12 weekly sessions focusing on pain management strategies and addressing trauma responses.
- Low-dose tricyclic antidepressants like amitriptyline can help reduce pain sensitivity, as supported by a retrospective cohort study in 81 IBD patients with functional GI symptoms 1.
- SSRIs such as sertraline or fluoxetine may be useful, especially when anxiety or depression coexist.
Medication and Lifestyle Modifications
- For acute pain episodes, peppermint oil capsules can provide relief through smooth muscle relaxation.
- Avoid long-term opioid use as it may worsen symptoms, as highlighted in the AGA clinical practice update on functional gastrointestinal symptoms in patients with inflammatory bowel disease 1.
- Lifestyle modifications including regular exercise, stress management techniques like diaphragmatic breathing or progressive muscle relaxation, and maintaining a food diary to identify trigger foods are important complementary approaches.
Importance of Multidisciplinary Care
- A multidisciplinary care team, including a psychologist with experience assessing and treating patients with chronic abdominal pain, is essential for providing the best and most effective assessment and treatment approach 1.
- Nonpsychologists should yield to mental health professionals on modality choice, and baseline therapy with instruction in breathing techniques and low-dose tricyclic antidepressants and serotonin noradrenergic reuptake inhibitors can be prescribed and managed by gastroenterologists.
From the Research
Tramadol-Related Functional Abdominal Pain Treatment
- The treatment of functional abdominal pain is a complex process that requires a comprehensive approach, including reassurance, education, and pharmacological or psychological interventions 2.
- Tramadol, a centrally acting analgesic, has been used to manage moderate to severe pain, including functional abdominal pain, due to its unique pharmacokinetic and pharmacodynamic profile 3, 4.
- However, the use of tramadol for functional abdominal pain treatment should be cautious, as it can lead to physical dependence and withdrawal symptoms, especially after abrupt discontinuation 5.
- Alternative treatment options for functional abdominal pain include antidepressants, such as tricyclic antidepressants, which have been shown to be effective in reducing pain and improving function 2.
- Psychological interventions, such as cognitive behavioral therapy, may also be beneficial as adjuvant therapy or as an alternative to treatment with antidepressants or opioids 2.
- Narcotics and benzodiazepines should be avoided in the treatment of chronic abdominal pain due to the high risk of physical and psychological dependence 2.
- Tramadol's mechanism of action, which involves opioidergic, noradrenergic, and serotonergic activities, makes it a potential option for managing functional abdominal pain, but its use should be carefully monitored and managed to minimize the risk of adverse effects 6, 3.