Functional Abdominal Pain Patient Subtypes in Childhood Predict Functional Gastrointestinal Disorders with Chronic Pain and Psychiatric Comorbidities in Adolescence and Adulthood

Overview

Journal Pain

Specialties Neurology
Psychiatry

Date 2012 Jun 23

PMID 22721910

Citations 98

Authors

Lynn S Walker

Amanda L Sherman

Stephen Bruehl

Judy Garber

Craig A Smith

Affiliations

Soon will be listed here.

Abstract

Although pediatric functional abdominal pain (FAP) has been linked to abdominal pain later in life, childhood predictors of long-term outcomes have not been identified. This study evaluated whether distinct FAP profiles based on patterns of pain and adaptation in childhood could be identified and whether these profiles predicted differences in clinical outcomes and central sensitization (wind-up) on average 9years later. In 843 pediatric FAP patients, cluster analysis was used to identify subgroups at initial FAP evaluation based on profiles of pain severity, gastrointestinal (GI) and non-GI symptoms, pain threat appraisal, pain coping efficacy, catastrophizing, negative affect, and activity impairment. Three profiles were identified: high pain dysfunctional, high pain adaptive, and low pain adaptive. Logistic regression analyses controlling for age and sex showed that, compared with pediatric patients with the low pain adaptive profile, those with the high pain dysfunctional profile were significantly more likely at long-term follow-up to meet criteria for pain-related functional gastrointestinal disorder (FGID) (odds ratio: 3.45, confidence interval: 1.95 to 6.11), FGID with comorbid nonabdominal chronic pain (odds ratio: 2.6, confidence interval: 1.45 to 4.66), and FGID with comorbid anxiety or depressive psychiatric disorder (odds ratio: 2.84, confidence interval: 1.35 to 6.00). Pediatric patients with the high pain adaptive profile had baseline pain severity comparable to that of the high pain dysfunctional profile, but had outcomes as favorable as the low pain adaptive profile. In laboratory pain testing at follow-up, high pain dysfunctional patients showed significantly greater thermal wind-up than low pain adaptive patients, suggesting that a subgroup of FAP patients has outcomes consistent with widespread effects of heightened central sensitization.

Citing Articles

Coping in youth living with chronic pain: A systematic review of qualitative evidence.

Woodgate R, Bell A, Petrasko J, Neilson C, Ayeni O Can J Pain. 2025; 9(1):2455494.

PMID: 40012718 PMC: 11864317. DOI: 10.1080/24740527.2025.2455494.

Painfully Sensitive: How Sensory Processing Sensitivity Affects Healthy Adolescents' Perception of Pain.

Hochreuter J, Wehrli S, Locher C, Lionetti F, Kossowsky J, Pluess M J Pain Res. 2025; 18:719-733.

PMID: 39975531 PMC: 11837743. DOI: 10.2147/JPR.S473575.

Depression in children with abdominal pain in the emergency department.

Martin S, Heyming T, Fortier M, Salas L, Huszti H, Dennis M Pediatr Res. 2025; .

PMID: 39824940 DOI: 10.1038/s41390-025-03871-y.

School absenteeism as a predictor of functional gastrointestinal disorders in children.

Tersteeg S, Borowitz S Front Pediatr. 2024; 12:1503783.

PMID: 39726527 PMC: 11669597. DOI: 10.3389/fped.2024.1503783.

Frequent Pain is Common Among 10-11-Year-Old Children with Symptoms of Attention Deficit Hyperactivity Disorder.

Berggren S, Bergman S, Almquist-Tangen G, Dahlgren J, Roswall J, Malmborg J J Pain Res. 2024; 17:3867-3879.

PMID: 39583198 PMC: 11585263. DOI: 10.2147/JPR.S472414.

References

Levy R, Whitehead W, Walker L, Von Korff M, Feld A, Garner M . Increased somatic complaints and health-care utilization in children: effects of parent IBS status and parent response to gastrointestinal symptoms. Am J Gastroenterol. 2004; 99(12):2442-51. DOI: 10.1111/j.1572-0241.2004.40478.x. View

Bergstrom C, Hagberg J, Bodin L, Jensen I, Bergstrom G . Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain. BMC Musculoskelet Disord. 2011; 12:81. PMC: 3097013. DOI: 10.1186/1471-2474-12-81. View

von Baeyer C, Champion G . Commentary: Multiple pains as functional pain syndromes. J Pediatr Psychol. 2011; 36(4):433-7. DOI: 10.1093/jpepsy/jsq123. View

Fillingim R, Maixner W, Kincaid S, Silva S . Sex differences in temporal summation but not sensory-discriminative processing of thermal pain. Pain. 1998; 75(1):121-127. DOI: 10.1016/S0304-3959(97)00214-5. View

Vlaeyen J, Linton S . Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000; 85(3):317-332. DOI: 10.1016/S0304-3959(99)00242-0. View

Mikkelsson M, El-Metwally A, Kautiainen H, Auvinen A, Macfarlane G, Salminen J . Onset, prognosis and risk factors for widespread pain in schoolchildren: a prospective 4-year follow-up study. Pain. 2008; 138(3):681-687. DOI: 10.1016/j.pain.2008.06.005. View

Saito Y, Mitra N, Mayer E . Genetic approaches to functional gastrointestinal disorders. Gastroenterology. 2010; 138(4):1276-85. PMC: 3829382. DOI: 10.1053/j.gastro.2010.02.037. View

Paananen M, Taimela S, Auvinen J, Tammelin T, Kantomaa M, Ebeling H . Risk factors for persistence of multiple musculoskeletal pains in adolescence: a 2-year follow-up study. Eur J Pain. 2010; 14(10):1026-32. DOI: 10.1016/j.ejpain.2010.03.011. View

Schurman J, Friesen C, Danda C, Andre L, Welchert E, Lavenbarg T . Diagnosing functional abdominal pain with the Rome II criteria: parent, child, and clinician agreement. J Pediatr Gastroenterol Nutr. 2005; 41(3):291-5. DOI: 10.1097/01.mpg.0000178438.64675.c4. View

10.

Helgeland H, Sandvik L, Mathiesen K, Kristensen H . Childhood predictors of recurrent abdominal pain in adolescence: A 13-year population-based prospective study. J Psychosom Res. 2010; 68(4):359-67. DOI: 10.1016/j.jpsychores.2009.10.010. View

11.

Lipsitz J, Gur M, Albano A, Sherman B . A psychological intervention for pediatric chest pain: development and open trial. J Dev Behav Pediatr. 2011; 32(2):153-7. PMC: 3139907. DOI: 10.1097/DBP.0b013e318206d5aa. View

12.

Claar R, Freeman Baber K, Simons L, Logan D, Walker L . Pain coping profiles in adolescents with chronic pain. Pain. 2008; 140(2):368-375. PMC: 3100727. DOI: 10.1016/j.pain.2008.09.007. View

13.

Robins P, Glutting J, Shaffer S, Proujansky R, Mehta D . Are there psychosocial differences in diagnostic subgroups of children with recurrent abdominal pain?. J Pediatr Gastroenterol Nutr. 2005; 41(2):216-20. DOI: 10.1097/01.mpg.0000170601.88263.50. View

14.

Gieteling M, Bierma-Zeinstra S, Passchier J, Berger M . Prognosis of chronic or recurrent abdominal pain in children. J Pediatr Gastroenterol Nutr. 2008; 47(3):316-26. DOI: 10.1097/MPG.0b013e31815bc1c1. View

15.

Zhou Q, Price D, Callam C, Woodruff M, Verne G . Effects of the N-methyl-D-aspartate receptor on temporal summation of second pain (wind-up) in irritable bowel syndrome. J Pain. 2010; 12(2):297-303. PMC: 3058359. DOI: 10.1016/j.jpain.2010.09.002. View

16.

Millan M . Descending control of pain. Prog Neurobiol. 2002; 66(6):355-474. DOI: 10.1016/s0301-0082(02)00009-6. View

17.

Gieteling M, Bierma-Zeinstra S, Lisman-van Leeuwen Y, Passchier J, Berger M . Prognostic factors for persistence of chronic abdominal pain in children. J Pediatr Gastroenterol Nutr. 2010; 52(2):154-61. DOI: 10.1097/MPG.0b013e3181e82a28. View

18.

Gatchel R, Peng Y, Peters M, Fuchs P, Turk D . The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007; 133(4):581-624. DOI: 10.1037/0033-2909.133.4.581. View

19.

Maixner W, Greenspan J, Dubner R, Bair E, Mulkey F, Miller V . Potential autonomic risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study. J Pain. 2011; 12(11 Suppl):T75-91. PMC: 3233841. DOI: 10.1016/j.jpain.2011.09.002. View

20.

Williams D, Clauw D . Understanding fibromyalgia: lessons from the broader pain research community. J Pain. 2009; 10(8):777-91. PMC: 2741022. DOI: 10.1016/j.jpain.2009.06.001. View