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Children with medically unexplained pain symptoms: categorization and effective management
Sharmishtha S Deshpande1, G Vidya, Neelima S Bendre
1Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India.
Indian Journal of Psychological Medicine
|February 21, 2012
Summary
Medically unexplained pain in children is increasing. Psychosocial stress, often unnoticed, underlies these symptoms and can be effectively managed with supportive therapy and medication.
Area of Science:
- Pediatric Medicine
- Child Psychology
- Psychosomatic Medicine
Background:
- Medically unexplained pain symptoms in children are increasingly prevalent.
- Pathophysiology is often unclear, necessitating better understanding for improved management.
- Limited literature exists on the assessment and management of these cases in India.
Purpose of the Study:
- To categorize pediatric cases of medically unexplained pain into subgroups for management.
- To explore the underlying causes and presentations of these conditions in children.
- To provide insights into the effective management strategies for these patients.
Main Methods:
- A retrospective case series of 17 children (10 boys, 7 girls) referred from pediatrics.
- Categorization of cases into three distinct subgroups based on management needs.
- Utilized Children's Apperception Test (C.A.T.) to uncover distress.
Main Results:
- Unnoticed psychosocial stress (academic, familial, parental illness) often preceded pain.
- Children experienced anxiety related to parental approval and fear of harm.
- Ineffective defense mechanisms like denial and repression were observed.
- Most children had average or borderline intelligence.
Conclusions:
- Somatic expression of emotional distress is common in children with medically unexplained pain.
- Supportive therapy and antidepressant medications were effective management strategies.
- Identifying and addressing subtle psychosocial stressors is crucial for treatment.
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