Psychogenic Abdominal Pain, Functional Abdominal Pain Syndrome? | Incheon Psychogenic Abdominal Pain

Incheon Psychosomatic Abdominal Pain

"My stomach hurts, but my intestines are perfectly fine," – The True Nature of Psychosomatic Abdominal Pain

No Pain Is Without Reason

Hello. This is Baekrokdam Korean Medicine Clinic.

Have you ever experienced something like this?

"My stomach often hurts, but the hospital says there's nothing wrong."
"My colonoscopy was clear, and the ultrasound showed nothing... So why does it keep hurting?"

In such cases, the usual response is:

"Isn't it psychosomatic?"
"It must be due to stress."

But how accurate are those statements? Today, we'll discuss this 'psychosomatic abdominal pain,' or more precisely, Functional Abdominal Pain Syndrome (FAPS).

1. What is Psychosomatic Abdominal Pain?

Psychosomatic abdominal pain, as the name suggests, refers to a condition where there are no structural abnormalities found during examinations, yet abdominal pain recurs repeatedly. Usually, when our stomach hurts, we assume there's a cause, whether it's food poisoning or enteritis. However, this case is different.

The pain can suddenly appear at any time of day, regardless of whether you've eaten or not, or whether you've used the restroom. Painkillers often don't work, and the pain can persist to the extent of interfering with daily life. This condition is not simply a 'sensitive constitution' but rather a state where the nervous system's sensory interpretation is misaligned.

2. How is it Different from IBS?

Irritable Bowel Syndrome (IBS) is a similar concept often confused with FAPS. However, the two conditions are distinctly different. IBS typically involves recurring abdominal pain along with diarrhea or constipation, and it has a strong correlation with bowel movements. FAPS, however, is primarily characterized by abdominal pain unrelated to bowel movements. In other words, the pain persists without changes in stool frequency or consistency.

Additionally, FAPS tends to occur at unpredictable times, and the intensity of the abdominal pain is often relatively constant.

3. Why Does It Occur?

Let's delve a bit deeper into the true nature of this abdominal pain:

• ① Visceral Hypersensitivity: This is a state where internal stimuli in the intestines, which would normally not cause pain, are interpreted as excessive pain.
• ② Gut-Brain Axis Dysfunction: Pain signals sent from the gut to the brain are exaggeratedly interpreted, or gastrointestinal function is worsened by stress.
• ③ Autonomic Nervous System Imbalance: Excessive activation of the sympathetic nervous system leads to increased pain sensitivity and decreased recovery capacity.
• ④ Emotional Factors: Anxiety, depression, and repressed emotions create a vicious cycle that intensifies the pain.

In essence, it can be seen as a 'malfunction of the brain that perceives pain in the abdomen.'

4. When Was It First Recognized?

In fact, this concept existed before, just under different names. In the past, terms like "hysterical abdominal pain" or "nervous abdominal pain" were used, often in a way that ignored or trivialized the patient's suffering.

Then, after the 1990s, with the development of the Rome criteria, the concept of functional gastrointestinal disorders became established. FAPS emerged as an independent diagnostic term, separate from IBS, only after the 2000s. More recently, such nervous system-based digestive disorders are collectively referred to as Gut-Brain Interaction Disorders.

5. How Can It Be Treated?

The core of psychosomatic abdominal pain is that the reality of the pain is genuine. Therefore, the goal of treatment is not simple suppression, but rather the modulation of the sensory interpretation circuit.

• Pharmacotherapy: Low-dose tricyclic antidepressants, neuromodulators, and antispasmodics are used.
• Cognitive Behavioral Therapy (CBT): A method to reduce pain by changing thought and reaction patterns to suffering.
• Relaxation Therapy, Sleep Improvement, Stress Management: These help restore autonomic nervous system balance.
• Traditional Korean Medicine Treatment: Acupuncture and herbal medicine can be administered concurrently, according to diagnostic patterns such as Liver Qi Stagnation (Gan-gi-ul-gyeol-hyeong), Phlegm Stagnation (Dam-ul-hyeong), or Qi Stagnation and Blood Stasis (Gi-che-hyeol-eo-hyeong).

The center of the pain is not the intestines, but the neural circuits. Psychosomatic abdominal pain is not pain to be ignored. The real problem is not the gut, but the system that processes pain. Such abdominal pain cannot be resolved by merely enduring it or suppressing it with painkillers. What we need to do is restore the damaged interpretive circuit, that is, re-tune the rhythm of both body and mind.

If you are currently suffering, that pain is by no means your imagination. It could be a signal for help from an 'invisible circuit.' Thank you.

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