How to recognize and manage psychosomatic pain in the pediatric emergency department

Abstract

Aim Children and adolescents affected by somatization and somatic symptom disorder commonly refer to emergency services. Due to the absence of specific guidelines for the emergency setting and to a possible lack of knowledge, these patients are at risk of being unrecognized and mismanaged. This study aims at proposing a clinical practice to approach and manage these patients and their families in the emergency setting. Methods This manuscript derived from the work of a research group of italian pediatric emergency physicians and anesthesiologists, with an expertise in pain management, members of the PIPER group. The research group reviewed the literature about psychosomatic pain and somatic symptom disorder and developed a clinical practice specific for the pediatric emergency setting. Results The manuscript provides information about the main clinical features shared by patients with psychosomatic pain and about current diagnostic criteria and appropriate management in the emergency setting. Furthermore, it highlights the possible pitfalls in which the emergency physician may run into dealing with these patients. Conclusion This clinical practice should be seen as a starting point toward a better understanding of patients with psychosomatic pain and a standardization of care in the pediatric emergency setting.

The utility of universal screening for somatization in a pediatric emergency department: A prospective evaluation

“…The immediate nature of the ED clinician’s invitation may explain the high follow-through we observed. Consistent with our findings, a direct and seamless approach to somatization intervention is supported by existing clinical recommendation and work done in primary care settings ( Abbass, 2005 ; Abbass et al, 2009 ; Cozzi et al, 2021 ). Our findings support the potential for cross-disciplinary collaboration between emergency and consultation psychiatry teams, in somatization identification and psychoeducation.…”

Significant Structural Alterations and Functional Connectivity Alterations of Cerebellar Gray Matter in Patients With Somatic Symptom Disorder

“…Pain symptoms may also reflect underlying structural abnormalities in the cerebellum. Pain is one of the most common symptoms among patients with SSD ( Kurlansik and Maffei, 2016 ; Cozzi et al, 2021 ; Nazzal et al, 2021 ). In this study, the most common complaints among patients with SSD were headache, fatigue, and dizziness.…”

Clinicians need to be careful that they do not confuse mental health issues and long COVID in children and adolescents

“…These included somatic symptom disorders, anxiety disorders and depression. 7 The specific clinical features reported by adolescents categorised as affected by long COVID seem to mirror the highly suggestive symptoms for somatic symptoms and mental health disorders in general. They have also been more prevalent in adolescents, patients with long‐lasting physical symptoms, severe fatigue and chronic pain and those who are unable to attend school because they feel sick, subjects socially isolated who and have a poor quality of life.…”

“… 7 As mentioned, adolescents with long COVID are likely to benefit from the same effective multidisciplinary therapeutic approaches, aimed to regain functioning, for patients with somatic symptom disorder. 7 Clinical practice experience and study data indicate that patients with features that suggested somatic symptom disorders frequently received other diagnostic labels, based on the types of symptoms and the clinics they were referred to. These may include chronic fatigue syndrome, fibromyalgia and chronic Lyme disease.…”