This chapter reviews and raises awareness of centrally mediated abdominal pain syndrome (CAPS), a poorly recognized functional gastrointestinal disorder. It focuses on the major contribution of central pain processing in the disorder and in doing so address differences in the way doctors and patients may explain the symptoms. CAPS, a challenging disorder for both clinicians and researchers, is often misdiagnosed as severe irritable bowel syndrome (IBS). While CAPS patients may also have irregular bowel movements, the latter are not associated with the abdominal pain as in irritable bowel syndrome (IBS). Symptomatic therapy – namely, for pain, diarrhoea, constipation and flatulence – is not effective in CAPS, so the treatment strategy should focus on centrally active treatments, both pharmacological and non-pharmacological. The assumption is that since severe IBS has a strong component of central sensitization, the treatment strategy should be effective in CAPS as well.