The Impact of Posttraumatic Stress Disorder on Clinical Presentation and Psychosocial Treatment Response in Youth with Functional Abdominal Pain Disorders: An Exploratory Study

Abstract

Youth with functional abdominal pain disorders (FAPDs) may report high rates of trauma and/or posttraumatic stress disorder (PTSD), which could impact both physical and psychosocial functioning, in addition to psychosocial treatment response. The current study aimed to examine the rates of PTSD in a sample of 89 youth with FAPDs and examine the association between PTSD with physical and psychosocial functioning. The impact of PTSD on psychosocial treatment response in a subsample of youth with FAPDs was also explored. Participants were youth with FAPDs (ages 9–14) enrolled in a larger study examining the effect of a short-term pain and anxiety focused cognitive behavioral therapy (CBT) treatment (Aim to Decrease Anxiety and Pain Treatment (ADAPT)) for youth with FAPDs. Youth were administered a semi-structured diagnostic interview by a trained clinician to confirm the presence of psychological diagnoses, including PTSD. Measures of physical and psychosocial functioning were also completed. Results revealed a high rate of PTSD in youth with FAPDs with 12.4% meeting diagnostic criteria for the disorder. PTSD was associated with several indicators of increased psychosocial impairment and one indicator of physical impairment. Exploratory analyses revealed comorbid PTSD may impact response to a brief CBT intervention targeting pain and anxiety, but more rigorous controlled studies are needed.

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

“…The experience of pain and impact on QOL can be markedly exacerbated by the coexistence of psychiatric diagnoses such as depression. [22][23][24] Our knowledge of predisposing genetic risks and how to treat mental health issues in patients with CP are in their early stages, but understanding the interaction between mental health and pancreatic pain may be very important for optimal patient management in the future. We conducted a literature search in PubMed for relevant English-language articles published before December 1, 2020.…”

Biomarkers of Allostatic Load as Correlates of Impairment in Youth with Chronic Pain: An Initial Investigation

“…One potential mechanism, which has been implicated in chronic pain maintenance, is allostatic load (AL), a multifactorial construct that represents the physiological "wear and tear" that prolonged and/or intensive stress can have on the body [6,10,11]. However, this construct has not received attention in studies of youth with chronic pain, despite the high incidence of ACEs and psychological stress observed in pediatric pain populations [17][18][19]23,45].…”

Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation

“…A host of research has identified strong overlap between neurobiological correlates of stress and of pain. 76 , 78 In addition, evidence suggests that youth with chronic pain report high rates of ACEs, 41 , 79 , 80 PTSS, 77 , 85 and general psychological stress 56 , 75 when compared with the general population or to matched nonpain peers. However, research remains limited on how a history or ongoing experiences of stress or trauma may influence the manifestation of chronic pain (eg, neurobiology) in youth or the course of and response to treatment.…”

“…This argument is further strengthened by preliminary evidence suggesting that youth with chronic pain and PTSD experience decreased response to non–trauma-focused CBT intervention. 77 Applying a trauma-focused lens to chronic pain intervention may include adapted elements of trauma therapies (eg, TF-CBT and narrative exposure) or streamlining care to mindfulness-based strategies. A strong body of research indicates that the nature of pain memories is highly predictive of long-term pain outcomes in youth.…”

“… 28 ) documented in pediatric pain populations. 75 , 77 , 79 , 80 Outside of pain, a large body of research highlights the malleability of the stress response and the ensuing “wear and tear” that stress can impose on the nervous system, most notably in youth (vs. adults). 19 , 44 , 59 , 66 , 67 , 69 Thus, modification of the stress response may decrease pain chronicity and impairment in vulnerable and affected youth; this hypothesis remains untested.…”