By Kathleen Raven
11:56 AM EDT, October 18, 2013
NEW YORK (Reuters Health) - Kids who dwell on or "catastrophize" chronic stomach pain are likely to have lower quality of life than children with a better attitude, but parents can help their kids learn to cope, German researchers say.
The new study also found - to the researchers' surprise - that young patients with chronic stomach pain reported lower quality of life than kids who deal with chronic asthma, skin rashes and even obesity.
"If the children think, â€˜My pain will not stop,' then this can lead to further impairment and increase psychological strain," said study co-author Claudia Calvano of the University of Potsdam in Germany.
Estimates vary, but past research has found that between 8 percent and 25 percent of all youth deal with chronic stomach pain, which can follow them into adulthood.
The researchers looked at two types of stomach pain - the kind for which doctors can identify a medical cause, called organic pain, and another type with no clear source, known as functional pain.
Functional stomach pain may result from interactions between stress, diet, exercise or psychological challenges and so it may be harder to pin down. Organic stomach pain may be accompanied by obvious symptoms like vomiting or fever.
When Calvano's group examined data on 170 kids and teenagers ages 8 to 18, the researchers found that poor coping skills, and not gender, economic status, or type of abdominal pain, was directly tied to lower quality of life scores.
The results also support previous research showing that having a diagnosis does not always help to deal with the pain.
"The way parents react is very important," Calvano said. A parent should acknowledge the pain - and not deny it - but he or she then needs to introduce the child to healthy coping strategies, she said. For example, frequently staying home from school may not help the child.
"Stress can increase the pain," she said, adding that the connection between the mind's stress and the abdomen is very sensitive in children.
The researchers suggest cognitive behavioral therapy (CBT) as a way to better handle the pain.
"Parents should be involved in the therapy and know which strategies the children learn so they can help them," Calvano said.
"Also, recognizing that fear and anxiety can be major causes of pain is very important," said Dr. Joel Rosh, a pediatric gastroenterologist at Goryeb Children's Hospital in Morristown, New Jersey.
Parents can watch out for different descriptions from kids, said Rosh, who was not involved in the new study. A young person who complains of a one-day stomachache could face a different problem than a child who has dealt with pain for three months, Rosh said.
He added that parents can ask questions to help their children, including: What does the pain feel like? Does it interfere with activities in the day? Is something new going on? What did you eat today?
"Too often, parents come away from an office visit thinking that the pain may be all in their child's head," Rosh said. "But the pain is very real and whether or not we can see something, we need to acknowledge the pain."
The researchers note that their study looked at participants at a single point in time, which limits the perspective of the study. Also, a majority - 72 percent - of children in the study dealt with food intolerances, and not inflammatory-related conditions like Crohn's disease and celiac disease, which could have affected the results.
"I was a little disappointed (about the study) because it only confirmed things that researchers have talked about before," said pediatric gastroenterologist Dr. Ritu Verma of The Children's Hospital of Philadelphia. However, she added that confirming past results is also valuable.
"From a gastroenterologist perspective, we may not read a lot of literature that deals with the psychology of abdominal pain, and that's important," said Verma, who treats kids with abdominal pain, but was not involved in the new study.
"There is a misperception that girls or women tend to have more issues with pain and quality of life. But here it confirmed that the gender of the patient did not make a difference," Verma told Reuters Health.
"Functional abdominal pain, even the kind without a clear cause, should be taken seriously by parents, school teachers and pediatricians," Calvano said.
"The doctor's office is the first place to begin dealing with the problem," she said.
"Sometimes children cannot get directed to psychological treatment," Calvano said.
"Children need training programs, and those programs need to be accessible to families," Calvano said.
SOURCE: http://bit.ly/18pxOeA Journal of Pediatric Psychology, online September 20, 2013.
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