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Maintenance of Pain in Children With Functional Abdominal Pain
Danita I Czyzewski1, Mariella M Self, Amy E Williams
1*Department of Pediatrics †Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine ‡Texas Children's Hospital, Houston, Texas §Indiana University School of Medicine & Riley Child and Adolescent Psychiatry Clinic, Indianapolis ||Children's Nutrition Research Center, Houston, Texas ¶George Washington School of Medicine and Health Sciences, Washington, DC.
Insights
Irritable bowel syndrome (IBS) symptoms in children with functional abdominal pain predict chronic pain, but anxiety does not. Pain and stool diaries, along with parent reports, effectively predict pain persistence.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
Background:
- Functional abdominal pain is common in children and can become chronic.
- Identifying predictors of chronic pain is crucial for effective interventions.
Purpose of the Study:
- To investigate if child anxiety and pain-stooling relationships predict the persistence of functional abdominal pain frequency.
- To compare the predictive accuracy of different methods (diary, parent report, child report) for assessing pain-stooling relationships.
Main Methods:
- Seventy-six children (7-10 years old) with functional abdominal pain were followed for 18-24 months.
- Baseline anxiety and pain-stooling relationships (using diaries, parent, and child reports) were assessed.
- The relationship between baseline factors and persistent pain frequency at follow-up was analyzed.
Main Results:
- Childhood anxiety at baseline did not predict pain frequency persistence.
- Children with baseline irritable bowel syndrome (IBS) symptoms maintained pain frequency.
- Children without a pain-stooling relationship showed decreased pain frequency; diaries and parent reports predicted persistence, unlike child reports.
Conclusions:
- Irritable bowel syndrome (IBS) symptoms in school-aged children with functional abdominal pain predict long-term pain persistence.
- Childhood anxiety is not a predictor of persistent functional abdominal pain.
- Prospective pain and stooling diaries and parent reports of IBS symptoms are reliable predictors of pain maintenance, whereas child self-reports are not.
Objectives:
A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report).
Methods:
Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency.
Results:
Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not.
Conclusions:
The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.
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