Chronic Abdominal Discomfort Syndrome (CADS): A Narrative Review of Treatment Strategies

Abstract

Mayank Gupta,1,* Anand S Patil,2,* Peter Staats,3 Michael E Schatman,4 Hemant Kalia,5 Dawood Sayed,6 Amol Soin,7 Ganesan Baranidharan,8 Leonardo Kapural,9 Ahish Chitneni,10 Paul Verrills,11 Sudhir Diwan,12 Alaa A Abd-Elsayed,13 Timothy R Deer14 1Kansas Pain Management and Neuroscience Research Center, Overland Park, KS, USA; 2St. Luke’s Rehabilitation Medical Center, Spokane, WA, USA; 3National Spine & Pain Centers, Frederick, MD, USA; 4Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 5Rochester Regional Health System, Rochester, NY, USA; 6The University of Kansas Health System, Kansas City, KS, USA; 7The Ohio Pain Clinic, Dayton, OH, USA; 8Leeds Teaching Hospitals NHS Trust, Leeds, UK; 9Carolinas Pain Institute, Winston-Salem, NC, USA; 10NewYork-Presbyterian, New York, NY, USA; 11Metro Pain Group, Clayton, VIC, Australia; 12Manhattan Spine & Pain, New York, NY, USA; 13University of Wisconsin-Madison, UW Health Pain Services, Madison, WI, USA; 14The Spine and Nerve Center of the Virginias, Charleston, WV, USA*These authors contributed equally to this workCorrespondence: Mayank Gupta, Email [email protected]: Chronic Abdominal Discomfort Syndrome (CADS) is a recently proposed term that is a subclassification of Chronic Abdominal Pain, characterized by symptoms affecting clinical, diagnostic, and functional domains. Patients with CADS often have a history of abdominal surgery and experience chronic gastrointestinal symptoms such as nausea, bloating, vomiting, and dyspepsia. This review explores the underlying pathophysiology of CADS, emphasizing the role of the sympathetic and parasympathetic nervous systems in pain transmission. Various pharmacological treatments are discussed, including acid suppressants, antispasmodics, and analgesics, highlighting their effectiveness and limitations. Non-pharmacological approaches such as intrathecal pumps, nerve blocks, peripheral nerve stimulation, and spinal cord stimulation are also examined, providing insights into interventional pain management strategies. The review underscores the necessity of an individualized treatment algorithm due to the complexity of CADS and the multiple pain generators involved. Ultimately, this paper advocates for a structured approach to CADS treatment, incorporating both emerging and established therapeutic options.Keywords: chronic abdominal pain, abdominal discomfort, abdominal pain treatment

Keywords

• Chronic Abdominal Pain
• Abdominal Discomfort
• Abdominal Pain Treatment