Centrally Mediated Disorders of Gastrointestinal Pain

We identified 3 centrally mediated disorders of gastrointestinal pain in the context of epidemiology, pathophysiology, clinical evaluation, and treatment, including pharmacotherapy, brain-gut behavioral therapy and neuromodulation, with an emphasis on the importance of the physician-patient relationship. Centrally mediated abdominal pain syndrome is characterized by chronic abdominal pain. It has 2 main categories: category A, when the pain occurs without association with physiological events, and category B, when there is a variable association of pain with physiological events. Centrally mediated abdominal pain is thought to be predominantly a result of central sensitization with altered processing of visceral pain by spinal and brain networks rather than heightened peripheral afferent nerve excitability. Abdominal migraine is newly recognized in adults with paroxysmal, stereotypical episodes of intense abdominal pain. Narcotic bowel syndrome, or opioid-induced gastrointestinal hyperalgesia, is characterized by the paradoxical development of, or increases in, abdominal pain associated with continuous or increasing dosages of opioids.