Severe and Refractory Chronic Abdominal Pain: Treatment Strategies Douglas A. Drossman  Clinical Gastroenterology and Hepatology  Volume 6, Issue 9, Pages 978-982 (September 2008) DOI: 10.1016/j.cgh.2008.04.024 Copyright © 2008 AGA Institute Terms and Conditions

Figure 1 Multicomponent treatment of FAPS. Treatment algorithm for FAPS. Beginning with an effective patient-physician relationship, treatments are added on the basis of the severity of the symptoms. Constipation if present is treated, and narcotics if present are withdrawn. Next prescribe a low-dose TCA or SNRI, and after 4–6 weeks this dosage can be increased while monitoring for clinical benefit and side effects. If this is unsuccessful, psychiatric referral should be considered for augmentation treatment with another antidepressant (eg, SSRI, bupropion), buspirone, or an atypical antipsychotic. On occasion, the patient might first be referred to a mental health counselor for psychological treatment. With more severe symptoms, combined pharmacologic and behavioral intervention is needed. Clinical Gastroenterology and Hepatology 2008 6, 978-982DOI: (10.1016/j.cgh.2008.04.024) Copyright © 2008 AGA Institute Terms and Conditions