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Visceral pain-associated disability syndrome: a descriptive analysis
Paul E Hyman1, Brenda Bursch, Manu Sood
1University of Kansas School of Medicine, Kansas City, Kansas, USA. phyman@kumc.edu
Journal of Pediatric Gastroenterology and Nutrition
|November 28, 2002
Summary
Pain-Associated Disability Syndrome (PADS) in children involves severe pain disproportionate to pathology. Associated factors include learning disabilities and family issues, requiring collaborative medical and mental health treatment.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Pain Medicine
Background:
- Pain-Associated Disability Syndrome (PADS) is defined by chronic pain causing severe functional limitations disproportionate to observable pathology.
- This study focuses on pediatric patients presenting with abdominal symptoms consistent with PADS.
Purpose of the Study:
- To describe the clinical features of pediatric patients diagnosed with visceral PADS.
- To identify factors associated with PADS in a pediatric cohort.
Main Methods:
- Retrospective review of 40 pediatric patients (7-21 years) with severe gastrointestinal symptoms impacting school attendance and eating for over 2 months.
- Patients met diagnostic criteria for visceral PADS, excluding feigned or self-induced pain, with failure of standard treatments and no clear organic cause for symptom severity.
Main Results:
- Abdominal pain was the dominant symptom (30/40), with all patients experiencing pain/discomfort and meeting criteria for functional gastrointestinal disorders.
- Common associated factors included learning disabilities, perfectionism, early pain experiences, dependent coping styles, family marital problems, and parental chronic illness.
- Triggering events included acute febrile illness (20/40) and school changes (11/40); comorbid psychiatric disorders were frequent, and invasive procedures often worsened symptoms.
Conclusions:
- Evaluation of pediatric patients with unexplained, incapacitating symptoms should include assessment for PADS-associated factors.
- Effective PADS treatment requires a collaborative approach by medical and mental health clinicians, recognizing both nociceptive and affective pain components.
- Avoidance of invasive procedures and surgery is crucial, as developmental issues likely play a role in PADS onset during preteen and early teen years.