CFAP is Chronic functional abdominal pain another one of the functional disorders without c or d or alternating.
Chronic Functional Abdominal Pain
By: Douglas A. Drossman, M.D.
http://www.aboutibs.org/Publications/CFAP.html
Diagnosing and Treating Patients with Refractory Functional Gastrointestinal Disorders
"Twelve key questions can be asked during the first visit to help determine the biopsychosocial nature of the condition and to help plan possible psychological referral or treatment.
1. Is the Pain Acute or Chronic?
Chronic pain is more strongly influenced than acute pain by higher brain centers or enhanced visceral sensation, so it is less likely that tissue pathology will be found with chronic pain. Thus, although acute pain is more likely to be associated with a single specific cause related to tissue damage, chronic pain has multiple, behavioral contributions. Acute pain is associated with physiologic arousal (such as tachycardia and diaphoresis) and anxiety, whereas chronic pain is associated with no arousal; the patient may even seem withdrawn or depressed [30].
For acute pain, peripherally acting analgesics and narcotics work well, and treatment includes rest. Recovery is expected after treating or removing the nociceptive source. For chronic pain, peripherally acting analgesics are not often helpful, narcotics are usually contraindicated, and treatment frequently involves increased physical activity and behavioral or psychopharmacologic treatment. Because recovery is rare, patients must learn to cope. However, with refractory pain, "sick-role" behavior can also be seen, in which the patient makes unconscious efforts to maintain the illness state.
2. Is There a Pain History?
Is this the only episode of significant pain, or does the patient have a long-standing history of painful gastrointestinal or other symptoms? Patients with frequent symptom episodes and visits to physicians for problems such as "gastroenteritis," back pain, headache, and dysmenorrhea communicate a long-standing pattern of somatic sensitivity, pain behaviors, or both. This gives a poorer prognosis for recovery.
3. Is the Pain Associated with Altered Gut Physiology?
Patients with intermittent pain that is typically brought on by eating, stress, or menses; that is associated with change in bowel function; or that is relieved by defecation or vomiting have a functional gastrointestinal disorder (such as the irritable bowel syndrome, functional dyspepsia, or functional constipation) [4, 13]. In these patients, the pain is related to changes in gut physiology that respond to treatments directed at the gut (such as cisapride [31, 32] and anticholinergic agents e). Conversely, constant pain not associated with changes in gastrointestinal function (such as chronic functional abdominal pain [13]) is modulated by higher brain centers; thus, gut-acting agents are not helpful. Treatment involves behavioral methods, psychopharmacologic methods, or both.
4. What is the Patient's Understanding of the Illness?
All patients hold certain perceptions about their illnesses and have expectations for treatment: their "cognitive schema" or belief system [34, 35]. If their beliefs are realistic and consistent with physician expectations, a mutually acceptable treatment plan is likely. However, many patients referred to medical centers have unrealistic beliefs about cause and treatment and are not satisfied by negative findings or the physician's reassurance. For example, the patient's belief that "there must be a medical (that is, 'organic') explanation for this pain" leads to continued medical consultations, hypervigilance to bodily sensations, and increased anxiety and arousal when no "cause" is found. A perpetual state of anxiety, physiologic arousal, and sensitivity to pain ensues, which only confirms (from the patient's perspective) the evidence for a physical cause."
http://www.annals.org/cgi/content/full/123/9/688
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My website on IBS is www.ibshealth.com
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