Given what we currently know about CAPS, the aim of treatment is to help you gain control over your symptoms and improve daily function, rather than totally eliminate symptoms, which usually is not possible.
One way to start is to keep a diary to record symptom flare-ups, and to identify possible triggers (emotional and situational). This kind of information may be used by you or your physician to help develop better strategies to control the symptoms.
The brain not only affects how you sense pain, it is also able to block pain. Think about the basketball player who sprains his ankle during a game and continues to play without awareness of pain. Then, when the game ends, he collapses to the floor, unable to walk. He was able to block the pain by focusing his attention on the game.
When nerve impulses travel up from the abdomen to the spinal cord, some of them go through a kind of "gate" that is controlled by nerve impulses coming down from the brain. These impulses from the brain can block or inhibit pain signals going from the abdomen to the brain by "closing" the gate. Alternatively, they can increase signals to the brain by opening the gate.
Because the brain has such a strong influence on the sensation of pain, psychological treatments can relieve symptoms of CAPS by sending signals that close the gate. Different techniques include relaxation, imagery, hypnosis, and cognitive-behavioral therapy.
Treatments – The Mind-Body Connection
- Symptom diaries – Help you see what events or emotions make symptoms worse.
- Stress management (i.e., relaxation techniques, meditation) – Teaches you how to focus attention on something other than the pain.
- Hypnosis – Helps you focus attention away from the pain. Positive suggestion can change ways you think or react.
- Cognitive-behavioral therapy – Teaches you how to change non-helpful thoughts, perceptions, and behaviors to control symptoms.
Medications may also be used in the treatment of CAPS. For continuous or severe abdominal pain, your doctor might prescribe an antidepressant. It is important to understand that these medications are not just used to treat individuals who have depression but also act as pain relievers (central analgesics) for treatment of CAPS and many other painful conditions.
Antidepressant medications can help stimulate the brain to increase the signals which block pain transmission from the abdomen to the brain. It may take several weeks before a difference is noticed.
Treatments – Antidepressant Medications
- Antidepressants act as pain relievers.
- These medications stimulate the brain to send signals and close the pain-control gate in the abdomen.
- Antidepressants might take several weeks to work, so you shouldn’t stop taking them until your doctor tells you to do so.
- Side effects are possible but usually go away after a few days.
Some people will experience side effects from antidepressant medications. Usually, the side effects will go away after a few days so it is important to stay with the medication until treatment benefit is obtained.
The tricyclic antidepressants (TCAs) can cause dry mouth and drowsiness. Another group of antidepressants is called selective serotonin norepinephrine reuptake inhibitors (SNRIs). These can cause side effects like nausea. Both of these classes of antidepressants are helpful for treating pain.
Finally, it is becoming increasingly common to use combinations of treatments like a medication for the bowel and an antidepressant or two types of medications to affect the brain’s pain control or a behavioral treatment like cognitive behavioral treatment with an antidepressant. These combinations can improve the pain benefit while keeping side effects at a minimum.
It is important to realize that narcotics are not indicated – and can even be harmful and need to be avoided – in treating chronic abdominal pain. Over long periods of time, narcotics may produce more pain causing a condition called "Narcotic Bowel Syndrome."