Recurrent Abdominal Pain, Anxiety, and Responses to Stress in Children and Adolescents

Abstract

Recurrent abdominal pain (RAP) is the most common type of recurrent pediatric pain. Much evidence shows that this condition adversely affects many areas of a child’s functioning, including repeated school problems and absences and frequent visits to pediatricians. Two striking features of RAP are the degree of comorbidity between RAP and anxiety, and the precipitating role that stress plays in predicting episodes of both RAP and anxiety. Therefore, this study compares children with RAP, children with an anxiety disorder, and a comparison group of children recruited from the community using a multi-method assessment paradigm. The three groups were compared using parent- and child-reports of somatization and anxiety, self-report and physiological measures of responses to stress and a laboratory test of pain tolerance and sensitivity. This research revealed that children with RAP experienced high levels of anxiety and other somatic symptoms in addition to abdominal pain. Further, children with RAP showed increased physiological arousal at baseline and during the laboratory stressors. Lastly, children with RAP reported increased pain sensitivity on a peripheral pain task indicating that their pain sensitivity may not be limited to visceral pain. These results suggest that both psychological and physiological factors may contribute to pain episodes in children with RAP and that recurrent abdominal pain may be part of a larger syndrome of somatization and anxiety. Further understanding of the links between RAP, stress, and anxiety is essential to understanding the development and progression of RAP, and in informing the prevention and treatment of the disorder.