Trajectories of Symptoms and Impairment for Pediatric Patients With Functional Abdominal Pain: A 5-Year Longitudinal Study

Abstract

Objective-This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain not associated with identifiable organic disease. Method-TheChildren's Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6-18 years old) seen in a pediatric gastroenterology clinic. Individual trajectories were empirically grouped and correlates of trajectory group membership at baseline were evaluated.Results-A model with three unique trajectories was found to adequately fit both symptom and impairment data. Two trajectories indicated relatively long-term improvement and one indicated continued high levels of symptoms and impairment. At baseline, the long-term risk group did not have the most severe pain but had significantly more anxiety, depression, lower perceived selfworth, and more negative life events.Conclusions-These results indicate that several distinct trajectories of relatively long-term outcomes may exist in children with functional abdominal pain. One trajectory indicated longterm risk for a high level of symptoms and impairment. Psychosocial correlates of long-term risk for physical symptoms and impairment, such as child-reported stress and internalizing symptoms, may be useful for treatment planning. Keywordsfunctional abdominal pain; somatic symptoms; impairment; trajectories; longitudinal; children Abdominal pain is one of the most common reasons for referral to pediatric primary care and gastroenterology clinics (Starfield et al., 1980). Recurrent episodes of pain over a period of several months or longer may affect as many as 10% to 24% of children and adolescents Hyams et al., 1996;Oster, 1972 pain in children is functional-without objective evidence of organic disease (Boyle, 1997;Walker et al., 2004). Some children with persistent abdominal pain also report a variety of additional symptoms including headaches, fatigue, dizziness, and nonspecific somatic complaints (Oster, 1972), suggesting the possibility of a somatization disorder (Ernst et al., 1984;Walker et al., 1991). Moreover, abdominal pain and associated somatic symptoms can have a considerable impact on children's daily functioning both academically and socially (Claar et al., 1999).Prospective studies have shown that many children with abdominal pain continue to complain of somatic symptoms and disability years after their initial evaluation (Apley and Hale, 1973;Christensen and Mortensen, 1975;Magni et al., 1987;Stickler and Murphy, 1979;Walker et al., 1995Walker et al., , 1998. For any patient population, however, the average longitudinal trajectory rarely describes all individuals. To date, subgroups of change have not been delineated for pediatric abdominal pain and the relationship between initial status and trajectories of change across time has not been investigated. Characterization of unique patterns of change is important because it may identify profiles of long-term risk that facilitate tailoring interventions fo...

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