Stress and recurrent abdominal pain.

We discuss the aetiology of recurrent abdominal pain of non-organic origin, according to the Rome Criteria for Functional Gastrointestinal Disorders and a psychogenic hypothesis. Stress activates the brain-gut axis, which is important for local gut symptoms, such as abdominal pain, but it also causes pain in other areas, including the head, back and chest. Our research has indicated that the startle reflex plays a dominant role in this stress-induced pain pattern, which is manifested in the whole body. Localised abdominal pain can be part of a general negative stress reaction that causes multiple pains in other areas of the body.

Effects of a person-centred approach in a school setting for adolescents with chronic pain-The HOPE randomized controlled trial.

BACKGROUND: Chronic pain among adolescents is common but effective interventions applicable in a school setting are rare. Person-centred care (PCC) is a key factor in improving health by engaging persons as partners in their own care. METHODS: In this randomized controlled trial, a total of 98 adolescents in secondary school or upper secondary school (aged 14 - 21 years) with chronic pain were randomly assigned to a PCC intervention or standard school healthcare. In the intervention group a pain management programme, based on a PCC approach, comprising four face-to-face sessions with a school nurse over a period of 5 weeks was added to standard school healthcare. The main outcome measure was self-efficacy in daily activities (SEDA scale) and rating scales for pain intensity and pain impact were used as secondary outcome measures. RESULTS: At the follow-up, no significant differences were found between the groups in the SEDA scale (p = .608) or in the rating scales for pain intensity (p = .261) and pain impact (p = .836). In the sub-group analysis, a significant improvement in the SEDA scale was detected at the secondary school in favour of the PCC intervention group (p = .021). CONCLUSION: In this pain management programme based on a PCC approach, we found no effect in the total sample, but the programme showed promising results to improve self-efficacy in daily activities among adolescents at secondary school. SIGNIFICANCE: This study evaluates the effects of a pain management programme based on a PCC approach in a school setting addressing adolescents at upper secondary and secondary schools with chronic pain. No overall effects were shown, but results illustrate that the intervention improved self-efficacy in adolescents at secondary school. Implementation of a PCC approach in a school setting may have the potential to improve self-efficacy in daily activities for adolescents with chronic pain at secondary school.

Development of the Help Overcoming Pain Early (HOPE) Programme Built on a Person-Centred Approach to Support School Nurses in the Care of Adolescents with Chronic Pain-A Feasibility Study.

Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care.

Antinociceptive fatty acid patterns differ in children with psychosomatic recurrent abdominal pain and healthy controls.

AIM: Stress is considered to trigger psychosomatic recurrent abdominal pain (RAP), but the mechanism behind the pain is unclear. Because the essential fatty acids, omega-6 and omega-3, are involved in pain, by regulating lipid mediators, we analysed the fatty acid patterns in children with RAP compared to healthy children. METHODS: This was a cross-sectional study of plasma phospholipid fatty acids in 22 consecutively included children with RAP, aged six to 16 years, at an outpatient clinic specialising in RAP. The controls were 100 healthy children previously reported on and analysed in the same laboratory. RESULTS: The children with psychosomatic RAP showed higher mean concentrations of saturated fatty acids than the controls (49.0 mol% versus 47.4 mol%) but lower mean levels of polyunsaturated fatty acids (38.6 mol% versus 39.9 mol%). Omega-3 fatty acids were lower in children with psychosomatic RAP, resulting in higher ratios of linoleic to alpha-linolenic acids (p < 0.001) and arachidonic to eicosapentaenoic acids (p = 0.01), despite a lower concentration of arachidonic acid in children with RAP (p < 0.01). CONCLUSION: The results suggested an imbalance between nociceptive omega-6 fatty acids and antinociceptive omega-3 fatty acids in psychosomatic RAP. Further studies, including lipid mediators and oxidative products, are necessary to confirm an association.

Recurrent pain, stress, tender points and fibromyalgia in childhood: an exploratory descriptive clinical study.

AIMS: To study the occurrence of tender points associated with fibromyalgia and their relationship with the stress-related pattern of tender points in children with psychosomatic recurrent abdominal pain. METHODS: In an exploratory descriptive study, 47 children aged 6-17 years with psychosomatic recurrent abdominal pain were examined for tender points associated with fibromyalgia and those associated with stress. The individual scores for these two types of tender point were correlated at inclusion and at follow-up after treatment. RESULTS: At inclusion, all children had a score for stress tender points that was near the maximum. Eight satisfied the diagnostic criteria for fibromyalgia. The scores for stress and fibromyalgia tender points were correlated significantly at both inclusion (R = 0.42, p < 0.005) and follow-up (R = 0.74, p < 0.00005). At follow-up, the children who were free of pain had significantly lower scores for stress tender points (p < 0.001) and fibromyalgia tender points (p < 0.00001) than those who were not pain free. CONCLUSIONS: Children with psychosomatic pain can have an increased risk of developing fibromyalgia. A longer duration of pain and more locations in which pain is felt might increase this risk. In patients with a favourable outcome, the scores for stress tender points and fibromyalgia tender points decreased significantly.

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.

SMS pain diary: a method for real-time data capture of recurrent pain in childhood.

OBJECTIVES: To capture recurrent pain in children aged 9-15 years reported by short message service (SMS) and to test the compliance of such reporting in a pilot study. METHODS: After instructions, 15 children reported their pain six times a day on SMS for a week and the compatibility of the reporting was evaluated. The pain was expressed and reported on three variables: intensity captured using a numeric rating scale (NRS-11), duration in minutes and a verbal pain-related disability scale with six alternatives (0-5). The validity of this scale was tested in 37 children, and the reliability in a test-retest procedure in 20 children. RESULTS: Good compliance reporting the three variables intensity and duration of pain as well as pain-related disability on SMS was indicated. Support for construct validity and reliability of the verbal instrument for pain-related disability was achieved. CONCLUSION: The study supports the hypothesis that pain experience expressed as intensity, duration and pain-related disability can be captured in real time by SMS in an inexpensive and compliant way in children aged 9-15 years. Validity and reliability was indicated for the constructed verbal pain-related disability scale. Further studies are needed to further confirm these findings.

Stressor, perceived stress and recurrent pain in Swedish schoolchildren.

OBJECTIVE: Stress is an important etiological factor for pain. Little is known, however, about how this process is mediated. The aim of this study is to highlight how more stress corresponds with the amount of reported perceived stress, pain symptom, and the co-occurrence of two pain symptoms--headache and abdominal pain--and how these three phenomena are related. We have also studied possible gender differences. METHODS: A cross-sectional study based on data from child supplements linked to national household surveys in Sweden during 2002-2003. Information concerning harassment, perceived stress, headache, and abdominal pain was gathered from a questionnaire. The study population consisted of a representative national sample of 2597 children aged 10-18 years. RESULTS: Children's reports of exposure to the stressor harassment were associated with their subjective perception of stress and recurrent pain in a stepwise manner. Having both pain symptoms was more strongly associated with the stressor harassment and perceived stress than having only one pain symptom. This was especially true of girls, who reported higher levels of stress symptoms and who had a different profile of pain symptoms than boys. CONCLUSIONS: The stressor harassment, perceived stress, and recurrent pain are associated with each other in a stepwise fashion. The co-occurrence of headache and abdominal pain is much more closely associated with harassment and perceived stress than any of these symptoms separately, especially in girls.