From the Research
Diagnosing Centrally Mediated Abdominal Pain Syndrome (CMAPS) requires a comprehensive approach based on clinical criteria and exclusion of other organic causes, with the most recent and highest quality study suggesting that the diagnosis relies primarily on the Rome IV criteria 1. The diagnosis of CMAPS is a complex process that involves a thorough medical history and physical examination, focusing on pain characteristics, psychological factors, and quality of life impact.
- Key diagnostic criteria include:
- Continuous or nearly continuous abdominal pain
- Minimal or no relationship to physiological events like eating or defecation
- Significant loss of daily functioning
- Symptoms persisting for at least 6 months Laboratory tests, including complete blood count, comprehensive metabolic panel, inflammatory markers, and stool studies, should be performed to rule out other conditions 1. Imaging studies, such as abdominal ultrasound, CT scan, or MRI, may be necessary to exclude structural abnormalities, and endoscopic procedures might be warranted if upper or lower GI pathology is suspected 1. Psychological assessment is crucial as CMAPS often coexists with anxiety, depression, or trauma history, and a multidisciplinary approach involving gastroenterologists, pain specialists, and mental health professionals typically yields the most accurate diagnosis and effective management plan 1. The diagnosis is ultimately one of exclusion, made when symptoms align with Rome IV criteria and other potential causes have been ruled out 1. It is essential to note that the pathogenesis of CMAPS has not been completely established, and various studies are being conducted to understand the underlying mechanisms, with central nervous system sensitization and disinhibition of pain signaling pathways playing a crucial role 2. A thorough understanding of the diagnostic criteria and a comprehensive approach to diagnosis and management are essential to improve patient outcomes and quality of life in CMAPS.