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. 2025 Jul 8:18:3451-3462.
doi: 10.2147/JPR.S524853. eCollection 2025.

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

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 Deer  14
Affiliations

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

Mayank Gupta et al. J Pain Res. .

Abstract

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: abdominal discomfort; abdominal pain treatment; chronic abdominal pain.

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Conflict of interest statement

Dr Peter Staats reports personal fees or grants from electroCore, nalu, saluda, AIS, Biotronik, outside the submitted work. In addition, Dr Peter Staats has a patent “Vagus Nerve Stimulation” licensed to electroCore. Dr Michael Schatman is a senior medical advisor for Apurano Pharma, outside the submitted work. Dr Hemant Kalia is a consultant for Abbott, nalu, curonix, Averitas, spr therapeutics, during the conduct of the study. Dr Dawood Sayed reports personal fees from PainTeq, Abbott, and Saluda; reports stock options from PainTeq and Surgentec, outside the submitted work. Dr Amol Soin reports research for Neuros medical, Avanos, and Neuronoff, outside the submitted work. In addition, Dr Amol Soin reports multiple patents related to neuromodulation issued to several pharmaceuticals. Dr Ganesan Baranidharan reports personal fees and/or grants from Nevro Corporation, Abbott, Mainstay Medical, Boston Scientific, and Saluda Medical, outside the submitted work. Dr Alaa Abd-Elsayed is a consultant for Medtronic, Curonix, Avanos and Averitas. Dr Timothy Deer reports personal fees for consultant, research and/or stock options from Abbott, SpineThera, Saluda Medical, Cornerloc, Boston Scientific, Pain Teq, Spinal Simplicity, SPR Therapeutics, Biotronik, Aurora, and Nervonik, during the conduct of the study. In addition, Dr Timothy Deer has a patent pending to Abbott. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
A proposed neuromodulatory approach to visceral pain predominant patient presentation.
See this image and copyright information in PMC

References

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