In Japan, physicians may overlook functional disorders in patients without detectable abnormalities, despite functional abdominal pain being a common human experience. Among functional gastrointestinal disorders (FGIDs), centrally mediated abdominal pain syndrome (CAPS) is notably difficult to manage and significantly impairs quality of life. CAPS is characterized by chronic abdominal pain unrelated to meals or defecation and lacks peripheral autonomic signs despite severe pain. It frequently coexists with psychiatric conditions and often leads to doctor shopping and unnecessary procedures. The pathophysiology suggests a central origin, involving central sensitization following peripheral nerve injury, diminished visceral sensitivity to physiological stimuli, and dysfunction of descending pain modulation systems. CAPS patients may also have impaired pelvic nerve function. Differential diagnoses include anterior cutaneous nerve entrapment syndrome (ACNES), abdominal epilepsy, and abdominal migraine. Management requires a multidisciplinary approach, including psychiatric support, education about CAPS, realistic goal-setting, and use of antidepressants or psychological therapies. Early recognition and appropriate intervention are essential to avoid worsening symptoms and dependency on narcotics. Internists and gastroenterologists play a critical role in identifying and managing CAPS to improve patient outcomes.