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Self-report assessment of recurrent abdominal pain
G Guariso1, R Mozrzymas, D Gobber
1Dipartimento di Pediatria, Università di Padova, Italia.
Insights
Recurrent abdominal pain (RAP) in children is best diagnosed by analyzing pain characteristics, not just intensity. Graphic pain representation, variability, and location offer key diagnostic insights for pediatric gastroenterology.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Pain Management
Background:
- Recurrent abdominal pain (RAP) is a common pediatric issue, often presenting as the primary symptom.
- Accurate diagnosis of RAP is crucial for effective treatment and management in children.
- Understanding the nuances of pain presentation is key to differentiating organic from non-organic causes.
Purpose of the Study:
- To analyze the clinical background of pain in children with RAP.
- To assess the pain's differentiating capacity in diagnostic evaluations.
- To explore the utility of self-rating pain methods in pediatric patients.
Main Methods:
- Studied 86 children with RAP at a pediatric gastroenterology service.
- Utilized verbal scales, Visual Analogue Scale (VAS), and the Eland graphic method for pain assessment.
- Classified children into three groups based on diagnostic procedures: upper GI disease, RAP without organic cause, and intestinal disease.
Main Results:
- Pain intensity did not effectively distinguish between the diagnostic groups.
- Variability in pain intensity, number/location of painful sites, and graphic representation were more informative.
- Children with RAP without organic cause showed detailed, colorful graphic pain representations with varied pain characteristics.
Conclusions:
- Graphic pain representation, alongside pain variability and location, aids in diagnosing pediatric recurrent abdominal pain.
- The Eland method and detailed pain history may enhance clinical evaluation standardization.
- Further clinical studies are needed to validate these diagnostic approaches.
Unlabelled:
Pain is the principal, and often the only symptom in cases of recurrent abdominal pain (RAP). The purpose of this study was to analyze the clinical background behind the pain symptom and the pain's capacity for differentiation in the diagnostic assessment of a group of 86 children suffering from RAP and observed at a pediatric gastroenterology service. The self-rating methods applied to the children included a verbal scale and a Visual Analogue Scale (VAS) for scoring the pain, and the Eland method, which is based on a graphic representation of the pain to enable its quantification and localization. Regardless of the pain assessment emerging from this study, the children were divided into 3 groups on the basis of a standardized diagnostic procedure, i.e. G1--upper gastrointestinal tract disease; G2--RAP with no apparent organic cause; G3--intestinal disease.
Results:
The intensity of the pain fails to distinguish between the three groups, while other features seem more useful, e.g. variability in the pain's intensity, the number and location of painful sites, and the how the pain is graphically represented. Drawings typical of RAP with no apparent organic cause characteristically represent the pain more accurately and in greater detail, using more colors and a certain refinement in the performance of the drawing, with varying types of pain in subsequent episodes, and involving several abdominal and even extra-abdominal sites. In our experience, this method might contribute towards the completion and standardization of the child's clinical history and clinical evaluation. Such methods would have to be validated by further clinical studies, however.