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Potential biobehavioral mechanisms of recurrent abdominal pain in children
Michael Feuerstein1, Ronald G Barr, Emmett T Francoeur
1McGill University and Allan Memorial Institute, Montreal, Que.Canada McGill University-Montreal Children's Hospital Research Institute and Montreal Children's Hospital, Montreal, Que.Canada.
Insights
Children with recurrent abdominal pain (RAP) do not show differences in autonomic nervous system recovery or pain responses compared to healthy children. This study found no evidence supporting altered stress recovery in children experiencing abdominal pain.
Area of Science:
- Pediatric Gastroenterology
- Neuroscience
- Psychology
Background:
- Recurrent abdominal pain syndrome (RAP) affects healthy children.
- Hypotheses suggest RAP involves autonomic nervous system (ANS) recovery deficits or heightened pain responses.
- Previous research lacks conclusive evidence on these mechanisms.
Purpose of the Study:
- To investigate autonomic nervous system recovery and pain responses in children with RAP.
- To compare children with RAP to healthy and hospital controls under stress.
- To validate hypotheses regarding ANS deficits and enhanced pain perception in RAP.
Main Methods:
- A cold pressor test was used to induce stress in children aged 9-14.
- Autonomic (heart rate, vasomotor), somatic (EMG), subjective (pain, distress), and behavioral (facial expression) responses were measured.
- Children with RAP were compared to matched hospital and healthy controls.
Main Results:
- The cold pressor stimulus caused significant arousal across all measured responses in all groups.
- No significant differences in autonomic, somatic, subjective, or behavioral responses were found between the RAP group and controls.
- Specifically, no autonomic recovery deficit was observed in children with RAP.
Conclusions:
- The findings do not support the hypothesis that children with RAP have impaired autonomic nervous system recovery to acute stress.
- The study suggests that differential responses to laboratory-induced stress are not a distinguishing factor for children with RAP.
- Further research may be needed to explore other potential mechanisms underlying recurrent abdominal pain in children.
Abstract:
To explain why otherwise healthy children experience recurrent episodes of abdominal pain (the recurrent abdominal pain syndrome, or RAP), it has been hypothesized that the child with RAP demonstrates: (1) a deficit in autonomic nervous system recovery to stress, and/or (2) an enhanced behavioral and subjective response to pain. To evaluate the validity of these assumptions, children with RAP (9-14 years) and hospital and healthy controls matched for age, sex, ethnicity and SES were exposed to a cold pressor stimulus (0 +/- 1 degree C). Autonomic (peripheral vasomotor and heart rate), somatic (forearm EMG), subjective (pain intensity and distress), and behavioral (facial expression) responses were recorded during baseline, stressor and recovery periods. At all 4 levels of observation, the cold pressor stimulus resulted in significant autonomic, somatic, subjective and behavioral arousal. However, no significant differential response across the 3 groups was noted for any measure and, in particular, no recovery deficit in autonomic arousal was demonstrated. These findings do not support the assumption of a differential response to an acute laboratory induced stress in children with RAP compared to control children.