Predictors of Chronic Abdominal Pain Affecting the Well-Being of Children in Primary Care

Leo A.A. Spee; Yvonne Lisman-van Leeuwen; Marc A. Benninga; Sita M. A. Bierma-Zeinstra; Boudewijn J. Kollen; Marjolein Y. Berger

doi:10.1370/afm.1736

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Abdominal pain in childhood associated with comorbid chronic pain conditions in adulthood
Barbara D. Reed, MD, MSPH

Published on: 19 March 2015

Published on: (19 March 2015)
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Abdominal pain in childhood associated with comorbid chronic pain conditions in adulthood
Barbara D. Reed, MD, MSPH, Professor of Family Medicine
Other Contributors:
Spee et al.[1] has identified 4 factors that predict continued abdominal pain in children who are followed over 1 year after presenting to their family physician with a new symptom of abdominal pain. The presence of high levels of other somatic complaints is one of those factors. The conclusions suggest that children with ongoing abdominal pain may need coordinated care between the family physician and those dealing with p...
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Spee et al.[1] has identified 4 factors that predict continued abdominal pain in children who are followed over 1 year after presenting to their family physician with a new symptom of abdominal pain. The presence of high levels of other somatic complaints is one of those factors. The conclusions suggest that children with ongoing abdominal pain may need coordinated care between the family physician and those dealing with psychosocial and/or stressor issues, including mental health care.
We propose that the presence of childhood chronic pain symptoms may indicate a propensity to neural hypersensitivity, and as a result, potentially to other chronic comorbid pain conditions over time. In response to the article by Spee et al, we ran statistics from our 5 year longitudinal population-based study of vulvodynia [2,3] to assess the relationship between participants reporting that they have had "stomach pains" before the age of 12, and subsequently screening positive in adulthood for vulvodynia, interstitial cystitis, irritable bowel disorder, and/or fibromyalgia. As shown in the Figure [annfammed.org/site/misc/TRACK/ReedFigure.doc], the greater the frequency of recalled stomach pains as a child, the greater the likelihood of screening positive for one or more of these comorbid pain conditions in our study.
While it is of value to consider known physical causes of pain in children as well as psychosocial correlates, the lack of evidence-based pathophysiologic explanations for pain in childhood does not mean such explanations do not exist. The increased understanding of comorbid pain conditions in adults, and the pathophysiologic changes (CNS, genetic, inflammatory markers, etc.) associated with these disorders needs to be pursued and assessed in children as well, as we attempt to understand the similarities and differences in pain conditions over the lifespan.
1. Spee LA, Lisman-van Leeuwen Y, Benninga MA, Bierma-Zeinstra SM, Kollen BJ, Berger MY. Predictors of chronic abdominal pain affecting the well-being of children in primary care. Ann Fam Med 2015;13:158-63.
2. Reed BD, Harlow SD, Sen A, Edwards RM, Chen D, Haefner HK. Relationship between vulvodynia and chronic comorbid pain conditions. Obstet Gynecol 2012;120:145-51.
3. Reed BD, Harlow SD, Sen A, et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol 2012;206:170 e1-9.
Competing interests: None declared
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Competing Interests: None declared.