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Severe and Refractory Chronic Abdominal Pain: Treatment Strategies

  • Douglas A. Drossman
    Correspondence
    Address requests for reprints to: Douglas A. Drossman, MD, UNC Center for Functional GI and Motility Disorders, 4150 Bioinformatics Bldg, CB# 7080, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599. fax: 919-966-8929
    Affiliations
    UNC Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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      A 33-year-old woman with chronic and severe abdominal pain refractory to all prior treatments was referred by her primary care physician. She first developed recurrent episodes of abdominal pain at age 6 years, which led to school absences, and the frequency and severity of these episodes increased after menarche. At age 19 after traveling through Mexico, she developed an acute gastroenteritis with worsening abdominal pain, diarrhea, fever, and vomiting and was diagnosed to have irritable bowel syndrome (IBS). During the last 10 years the pain has become more frequent, and for the last 5 years the pain is constant and associated with abdominal bloating and constipation. Additional diagnoses include fibromyalgia and occasional migraine headaches treated with sumatriptan.

      Abbreviations used in this paper:

      FAPS (functional abdominal pain syndrome), IBS (irritable bowel syndrome), SNRI (serotonin-norepinephrine reuptake inhibitor), SSRI (selective serotonin reuptake inhibitor), TCA (tricyclic antidepressant)
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