Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders

Abstract

WHAT'S KNOWN ON THIS SUBJECT: At the time of their pediatric medical evaluation, patients with functional abdominal pain (FAP) have higher levels of emotional symptoms compared with youth without FAP. No controlled prospective study has evaluated psychiatric outcomes for FAP patients in adulthood. WHAT THIS STUDY ADDS:This prospective study showed that pediatric FAP was associated with high risk of anxiety disorders in adolescence and young adulthood. Risk was highest if abdominal pain persisted, but was significantly higher than in controls even if pain resolved. abstract BACKGROUND: Cross-sectional studies link functional abdominal pain (FAP) to anxiety and depression in childhood, but no prospective study has evaluated psychiatric status in adulthood or its relation to pain persistence.METHODS: Pediatric patients with FAP (n = 332) and control subjects (n = 147) were tracked prospectively and evaluated for psychiatric disorders and functional gastrointestinal disorders (FGIDs) at followup in adolescence and young adulthood (mean age = 20.01 years). Participants were classified according to presence (FGID-POS) or absence (FGID-NEG) of FGIDs at follow-up.RESULTS: Lifetime and current risk of anxiety disorders was higher in FAP than controls (lifetime: 51% vs 20%; current: 30% vs 12%). Controlling for gender and age, the odds ratio was 4.9 (confidence interval = 2.83-7.43) for lifetime anxiety disorder and 3.57 (confidence interval = 2.00-6.36) for current anxiety disorder at follow-up for FAP versus controls. Lifetime risk of depressive disorder was significantly higher in FAP versus controls (40% vs. 16%); current risk did not differ. In most cases, initial onset of anxiety disorders was before pediatric FAP evaluation; onset of depressive disorders was subsequent to FAP evaluation. Within the FAP group, risk of current anxiety disorders at follow-up was significantly higher for FGID-POS versus FGID-NEG (40% vs 24%), and both were higher than controls (12%); current depressive disorders did not differ across FGID-POS, FGID-NEG, and controls. CONCLUSIONS:

Comorbidity of Mental Disorders and Chronic Pain: Chronology of Onset in Adolescents of a National Representative Cohort

“…However, comparisons of comorbidity rates across studies should be made with caution because of methodological differences and cohort effects. Although our results suggest that mental disorders precede chronic pain rather than vice versa, there is also some evidence of the reverse direction, 30,88 thereby highlighting the importance of further studying the unfavorable pattern of co-occurring chronic pain and mental disorders.…”

“…This is surprising given the developmental trajectory of both conditions. 53,56,60,70,80,83,100 There is particular evidence of the relationship between child/adolescent chronic pain and adult psychiatric symptoms 15, 30,43,60,88 and, vice versa, the relationship between child/ adolescent mental disorders and chronic pain in adulthood. 62,87 Some studies support a relationship between recurrent abdominal pain and mental disorders or symptoms in children and adolescents.…”

One-year course and predictors of abdominal pain in children with autism spectrum disorders: The role of anxiety and sensory over-responsivity

“…For example, recurrent abdominal pain in children has been associated with increased anxiety (Dufton, Dunn, & Compas, 2009;Dufton, Dunn, Slosky, & Compas, 2011;Walker & Greene, 1989). Longitudinal studies from the general population indicate that anxiety can contribute to the development of functional gastrointestinal problems over time (Koloski et al, 2012;Mulvaney, Lambert, Garber, & Walker, 2006), and that anxiety symptoms often pre-date the onset of functional abdominal pain in children (Shelby et al, 2013). Physiological studies have also found evidence of increased physiological stress reactivity (Dufton et al, 2011) and increased auditory startle reflexes (Bakker, Boer, Benninga, Koelman, & Tijssen, 2010) in children with functional abdominal pain.…”

Subliminal (latent) processing of pain and its evolution to conscious awareness

“…For example, following remission of CRPS, patients may still have chronic pain later even after apparent remission (Anderson and Fallat, 1999). (2) Delayed Relapse – Pain in children may remit and then be present either in a multiple pain format including vulnerabilities of comorbidities (e.g., depression or anxiety) or in the same disease (e.g., irritable bowel syndrome, IBS), years later (Shelby et al, 2013; Walker et al, 2010, 2012). …”