Enfoque de las causas no orgánicas de dolor abdominal recurrente en niños / Focus on non-organic recurrent abdominal pain in children

El dolor abdominal recurrente de causa no orgánica es frecuente en los niños. La mayoría de ellos padecen de estrés negativo, que provoca el dolor. En este artículo se destaca la importancia de mantener una mentalidad abierta al momento de encarar la investigación de la etiología del dolor. Se presentan los criterios diagnósticos del dolor psicosomático. Se describen los síntomas físicos del estrés. Se indican las áreas importantes y los mecanismos del estrés en la mente y en el cuerpo. Se discuten dos estudios, uno publicado anteriormente y otro más reciente, acerca del tratamiento psicosomático. Los resultados son alentadores por lo que se recomiendan más investigaciones.

Interacting organic and psychosocial factors in children suffering from recurrent abdominal pain

Recurrent abdominal pain [RAP] in Children is a common problem, yet frustrating when unexplained. To estimate the incidence of recurrent abdominal pain in children in Alwahda outpatients clinics, Derna - Libya 1/7/2007 to 31/12/2007, and the possible contributing factors. Out of 2551 [1272 males and 1279 females] children, 437 [200 males and 237 females] were suffering from RAP [17.13%]. Those children were subjected to clinical evaluation, laboratory investigations [urine, stool, complete blood picture], abdominal ultrasonography, psychosocial screening using Pediatric Scale Checklist. The causes of RAP were 44.85% organic, 5.9% psychosocial, 44.39% interacting organic and psychosocial, and 4.81% functional RAP [functional abdominal pain in 52 [12%] children, IBS was diagnosed in 38 [8.7%] children, while nonulcer dyspepsia was diagnosed in 10 [2.3%] children. The most common organic causes of RAP were parasitic infestations in 210 [48%] of children [23.57% oxyuris, 19.22% Giardia lambilia and 11.67% Ascaris], urinary tract infections in 98 [22.43%], and chronic constipation in 57 [13.04%] of children. The results of this study have a bearing on the management of childhood RAP

Associação entre eventos estressantes de vida e dor abdominal recorrente não orgânica: revisão / The association between stressful life events and non organic recurrent abdominal pain: review

A Dor Abdominal Recorrente Não Orgânica (DARNO) é um problema comum nos consultórios de pediatria e gastroenterologia infantil. O objetivo deste estudo é revisar os trabalhos da literatura científica sobre a associação entre DARNO e eventos estressantes de vida considerando os fatores moduladores da percepção dolorosa (competência social, somatizações parentais, enfrentamento). Foram avaliados 22 publicações sendo 9 descritivas, 10 estudos caso-controle, um estudo coorte, um ensaio clínico e um de revisão. A faixa etária estudada estava entre 1 e 19 anos. Os eventos estressantes mais comumente associados à DARNO estavam relacionados com o ambiente familiar. Os resultados a respeito da influência dos fatores sócio-econômicos foram contraditórios. A idade mostrou ter uma associação positiva com a freqüência dos eventos de vida. A capacidade de adaptação da criança e adolescente frente ao estresse é um fator moderador na percepção dolorosa. A presença de eventos estressantes de vida em indivíduos com adequada competência social não esteve associado com aumento dos sintomas de dor. As somatizações parentais estão diretamente relacionadas com aumento destas queixas nos filhos. Baseados nestes resultados, concluímos que a identificação precoce de eventos estressantes de vida e de fatores moduladores da percepção dolorosa em crianças com DARNO associado ao estabelecimento de programas de prevenção e tratamentos são condutas necessárias e essenciais na abordagem clínica destes pacientes.

The Non Organic Recurrent Abdominal Pain (NORAP) is a common problem in pediatric and infant gastroenterology centers. The aim of this study was to review the published literature about the associaton between NORAP and the stressful life events considering moderator factors of pain perception (social competence, parental somatic symptoms, copying). Twenty two articles were evaluated, 9 of the descriptive, 10 case-control studies, one cohort, one review and one randomized clinical trial. The children and adolescents aged from 1 to 19 years. The stressful life events mostly associated to NORAP were related to the family environment. The socio-economic factors showed contradictories results. The age showed a positive influence to the frequency of life events. The capacity of adaptation of a child and adolescent facing stress is a moderator factor in the pain perception. Higher levels of family stressors and parental somatic symptoms predict higher levels of somatic complaints by children. Among children and adolescent with high social competence, higher levels of family stressors were not associated with more somatic complaints. Thus, the results shows that the early identification of the stressful life events and the moderator factors of pain perception in children and adolescents with NORAP and a preventive and curative programs are important to evaluate this patients.

Frequency and etiology of psychogenic pain disorders in children and adolescents

To find out the frequency and etiology of psychogenic pain disorders in children and adolescents of NWFP, Pakistan. A descriptive hospital based study. From October 2000 to April 2003 at Paediatric Department PGMI, Lady Reading Hospital, Peshawar, NWFP, Pakistan. The referral cases of 100 children and adolescents presenting only with psychogenic pain disorders were included in the study. Each patient was administered self-constructed semi-structural interview schedule including relevant psychosocial information. Among 100 patients, 58% were boys and 42% were girls with mean age 10.21 years and SD 2.51. The 62% children were educated [upwards arrow] 5[th] class. Forty five percent of the sample reported psychogenic abdominal pain whereas psychosocial etiological factors included 38% children with different temperaments, 31% with adjustment problems, 17% were faulty child rearing styles and 14% with academic problems. It is evident from the research findings that there are significant numbers of children with psychogenic pain disorders as a result of specific psychosocial etiological factors

Cáncer de vesícula: manejo del dolor y otros síntomas / Gallbladder cancer: pain and other symptoms management

El cáncer de vesícula es generalmente diagnosticado tardíamente, por lo cual manejar adecuadamente los síntomas y optimizar la calidad de vida es fundamental. El dolor es generalmente de origen visceral y en su manejo se privilegia la vía oral y subcutánea, según el concepto de escalera analgésica de la OMS; esto facilita el acceso de los pacientes a la analgesia opioide y a los fármacos coadyuvantes. Los métodos invasivos son: analgesia espinal y bloqueo neurolítico de plexo celíaco.Otros síntomas como náuseas y vómitos, anorexia, astenia, constipación, ictericia y prurito, edema de extremidades, ascitis, singulto y cuadros ansioso-depresivos, se tratan con diversas estrategias farmacológicas y no farmacológicas. La atención de los problemas psicosociales del paciente y su familia es también muy importante. En la experiencia del Instituto Nacional del Cáncer entre 1994 y 2001, se observa un incremento progresivo de los pacientes con cáncer de vesícula avanzado, describiéndose la incidencia, evolución y tratamiento de 120 pacientes con distintos síntomas de una patología cuya sobrevida fue entre 1 y 224 días (promedio 49.8 días) y en los cuales se aplicó un modelo de manejo integral del paciente, bajo el concepto de medicina paliativa.

Gallbladder cancer is diagnosed too late most of the time. For this reason symptomatic management and improve quality of life is essential. Pain has visceral origin and must be alleviated using the WHO analgesic ladder strategy by oral or subcutaneous route. Access of patient to different opioids and coadyuvants is mandatory. Invasive methods for analgesia includes spinal analgesia and neurolityc celiac plexus block. Other symptoms like nausea and vomits, anorexia, asthenia, constipation, jaundice and pruritus, lower limbs oedema, ascites, hiccup, and depressive states, need pharmacological and non pharmacological approach. Psychosocial intervention is advisable. Analysing "Instituto Nacional del Cáncer" experience since 1994 to 2001, a progressive increment in patients with gallbladder cancer is observed, describing the incidence, evolution and management of pain and others symptoms in 120 patients with this pathology. Mean survival of patients was between 1 and 224 days, (mean 49,8 days). An integral management of palliative medicine was applied.

Chronic abdominal pain in children

Children in the age group of 5 to 12 years, attending a paediatric outpatient department, were evaluated to determine the prevalence, and also to elucidate the causes of chronic abdominal pain. 10.5% of the children were found to be suffering from chronic abdominal pain. The maxium affection was seen in the age group of 7 to 9 years. The proportion of affected girls was twice[14.7%] compared to boys [7.5%]. The location of pain was periumbilical in nearly half of the cases. 2.5% of the children had UTI and abdominal sonography carried out in 128 instances was abnormal in 3% of the cases. Nervous, excitable and apprehensive personality traits were strongly related with chronic abdominal pain, so also the presence of enuresis. Children with chronic abdominal pain had significantly more school absences compared to the controls. Out of six emotional problems analysed to assess their association with chronic abdominal pain, single parenting, chronic illness in the mother and father and excessively rigid parenting were found to have significant relationship. The results of this study suggest that chronic abdominal pain is a relatively common complaint in children. A good history, physical examination and minimal laboratory investigations usually provide a direction either towards an organic cause or a functional/psychological etiology

Tratamiento psicosocial del dolor abdominal crónico

Los pacientes con dolor abdominal crónico refractario pueden presentar psicopatología hasta en un 15 por ciento de los casos. La intervención psicosocial puede ayudar a controlar el dolor y prevenir la discapacidad. Se presentan seis casos de dolor abdominal crónico refractario que no recibieron tratamiento psicosocial complementario a su tratamiento gastroenterológico con resultados positivos en términos de control del dolor y prevención de discapacidad

Caracterización clínica y psicológica de escolares y adolescentes con dolor abdominal recurrente / Clinical and psychological characterization of children with recurrent abdominal pain

In order to characterize further the nature of emotional factors in RAP patients, we conducted a controlled psychological evaluation of 46 consecutive new patients with RAP, aged 7-17 (group A) by mean of structured interviews and questionnaires. Two control groups of pediatric patients with chronic illnesses were also assessed using the same methodology. Group B consisted of 22 individuals with chronic abdominal pain and endoscopiy-proven peptic ulcer or duodenitis and group C consisted of 24 individuals with chronic, stable, non gastroenterological diseases (diabetes mellitus or physical handicaps). Parents were evaluated for depressive symptoms

Dolor abdominal recurrente en niños: un trastorno psiquiátrico?

Objetivo: reconfigurar los elementos históricos, conceptuales, descriptivos, problemáticos y del tratamiento de los niños con dolor abdominal recurrente (DAR) a partir de 1985. Método: se trata de una revisión documental sobre los principales artículos que se han producido sobre el tema entre 1985 y 1990. El criterio de inclusión fue que ofrecieran aportes en el desarrollo de cualquiera de los parámetros antes enunciados. Resultados: la primera descripción de la enfermedad se hizo con el modelo del par antitético: orgánico versus psicogénico, la cual atribuía el dolor a conflictos psicológicos y por lo tanto se trataba de un enfermo psiquiátrico; a la luz de los nuevos conocimientos actualmente se considera que los factores orgánicos, emocionales, funcionales y de percepción modulan sustancialmente esta experiencia dolorosa sin que ninguno de ellos la explique totalmente, es un producto de su interacción. Se enuncian los principales problemas clínicos que se afrontan en la atención de esta dolencia y se propone un modelo detallado para su tratamiento.

Dolor abdonimal recurrente en niños: los factores emocionales

El diagnóstico de dolor abdominal recurrente (DAR) se hace en los niños cuando la patología dolorasa es de frecuencia e intensidad suficiente para alterar el funcionamiento escolar del paciente. Estos niños tiene inteligencia normal,historia de quejas somáticas múltiples,ansisos,tímidos,hiperconcientes de lo que les sucede y con antecedentes familiares de alteraciones emocionales. Se presenta una revision sobre la etiología,el tratamiento y los factores que concurren el problema señalado que una tercera parte de los niños tendrán seguramente trastorno de somatización en su edad adulta, el otro tercio continua presentando problemas dolorosos y solamente el tercio restante se muestra en la adultez sin síntomas dolorosos