BETHESDA, MD. – Recurrent abdominal pain appears to be part of a larger syndrome of somatization and anxiety, Lynette Dufton reported at a meeting sponsored by the National Institutes of Health Pain Consortium.
Physiologic factors may contribute to pain episodes in children with recurrent abdominal pain, “but I think anxiety is a key part of this,” said Ms. Dufton of Vanderbilt University in Nashville, Tenn.
“Providers should assess comorbid psychological symptoms in these children, and maybe refer them for [therapies such as] cognitive-behavioral therapy,” she said in an interview at her poster presentation on the study.
Using various parent and child reports of somatization and anxiety, different measures of stress reactivity, and the “cold pressor” test of pain tolerance and sensitivity, Ms. Dufton compared 21 children with recurrent abdominal pain (9 boys) with 21 children with a diagnosed anxiety disorder (11 boys) and 21 children who were well (9 boys). The children in each group had a mean age of either 11 or 12 years.
A total of 67% of the children with recurrent abdominal pain–a problem experienced by 8%–25% of school-aged children–met criteria for an anxiety disorder, compared with 100% of the children with anxiety and 6% of the well children.
On parent and self-reports of somatization and anxiety, such as the Child Behavior Checklist for Ages 6–18 (CBCL/6–18) and the Youth Self-Report, children with recurrent abdominal pain rated significantly higher on internalizing symptoms, such as anxiety and somatic complaints, than did well children.
They did not differ from children with anxiety disorders on the CBCL's measures of anxiety, but they did report significantly more somatic complaints, Ms. Dufton said.
Children with recurrent abdominal pain also reported different levels of stress reactivity on various measures from those reported by well children. On one self-reported measure–the “Responses to Stress Questionnaire”–those children exhibited higher levels of stress reactivity than both well and anxious children.
The cold pressor test measures the length of time one can keep one's hand and arm in ice-cold water (pain tolerance) and rates pain at 40 seconds using a visual analog scale (pain sensitivity). Unexpectedly, there were no differences in pain tolerance among the groups of children, Ms. Dufton said.