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Children with chronic, unexplained abdominal pain are far more likely to suffer from anxiety when they grow up – even if the stomach problems eventually disappear, a new study shows.
Of adults who had abdominal pain as children, 51 percent had experienced an anxiety disorder during their lives, compared to 20 percent of those who didn’t experience tummy aches as children, according to research published in Pediatrics Monday. As adults, a full 30 percent of the childhood abdominal pain sufferers were still coping with some kind of anxiety disorder, compared to 12 percent of their no-pain peers.
While it’s been long known that children with functional abdominal pain are more likely than others to have depression and anxiety in childhood, this is the first research to show anxiety follows kids into adulthood.
“The most important finding is they had clinically significant anxiety in long-term follow-up, even if they no longer had abdominal pain,” said the study’s lead author Lynn Walker, a professor of pediatrics and director of the division of adolescent and child health at Vanderbilt University School of Medicine. “We’ve known these children often have anxiety and you could argue that stomach aches make you anxious. But this shows there seems to be a longstanding susceptibility to anxiety disorders.”
For the new study, Vanderbilt researchers followed 332 children between the ages of 8 and 17 who were diagnosed with functional abdominal pain and 147 with no pain for an average of eight years. At the outset all the kids were asked along with their parents to fill out questionnaires designed to ferret out mental health issues. On follow-up, the researchers interviewed the volunteers -- who were on average age 20 at that point -- either in person or by phone.
The researchers found that the most common diagnosis for the abdominal pain sufferers, both while young and after they were grown, was social anxiety disorder.
“You get into a vicious cycle of avoiding activities and isolating yourself because of the pain,” she explained. “And what that does for kids is, it creates stress. They fall behind in school and get out of sync with their peers. Because they’re not involved in things, it gives them more time to focus on their pain and to worry about it.”
For one Tennessee mother, it was frightening to see her 4-year-old daughter suddenly and inexplicably start to experience daily stomach pains.
“We were really, really worried that something was going to be majorly wrong,” said Kathy, who requested her last name not be published to protect her daughter’s privacy.
After tests showed no underlying problems, the family noticed a connection between stress and stomach pain in the young girl, now 14. “It’s very interesting that the stress [that triggers flare-ups] can be either positive or negative,” Kathy said. “So it’s not just being nervous or afraid of something. It can be happy things, too.”
Stress management such as slowed breathing, walking, praying and focusing on “happy things” helped her condition, Kathy said.
Gastroenterologist Dr. Ritu Verma called the study 'very, very exciting," saying it may help pediatricians and parents better understand the connection between "the mind and the gut."
Often parents and kids – especially teens – are loath to see a psychologist for functional abdominal pain because of the stigma attached to mental health issues, Verma said.
“Hopefully that will make it easier for them to partner up with a behavioral health professional," said Verma, section chief off clinical gastroenterology at the Children’s Hospital of Philadelphia.
Recent studies show certain kinds of behavioral therapy can reduce both anxiety and pain, said Dr. Eva Szigethy, director of the medical coping clinic at the Children’s Hospital of Pittsburgh.
A 2010 study out of Holland “showed that hypnotherapy not only significantly decreased functional abdominal pain over a 12 month period, but it also had a great impact five years out,” Szigethy said.
Szigethy said the therapy being studied is not like stage hypnosis, which she says has given hypnosis a bad name.
The kind of hypnosis used by therapists for kids with abdominal pain “really means tapping into their ability to daydream and imagine things visible, to put their minds somewhere else,” Szigethy said, adding that therapists at her clinic have had success with these methods.
Pediatric psychologist Brenda Bursch sees important broader implications from the research.
“[It] confirms what many clinicians have long suspected: that their patients with chronic pain have an underlying tendency to be anxious that persists over time,” she said. “While everyone responds physically to stress, some individuals are more prone to pain than others, and some are more distressed or disabled than others by pain.”
That tendency is partly genetic and partly environmental, according to Bursch, professor of clinical psychiatry at the David Geffen School of Medicine at UCLA.
“Some of us had parents who told us to go to school when we had a stomach ache and some had parents who brought us to the emergency room,” she said. “How a parent responds will teach a child how much to worry about a physical symptom and what might be an appropriate response. Repeated patterns of interaction between parent and child can have long term effects on the child’s central nervous system, including how they physiologically respond to stress.”
Parents should encourage their children to continue normal activities despite the pain, said Walker. “That can be very hard if the parent has a child who is terrified of the pain, and is crying and doubled over in pain,” she acknowledged. “It’s also important to find ways to support the child’s interests and activities outside of the ‘sick role.’ So if a kid really likes to draw, get them art lessons or if you’ve got a dog, get them involved in training the dog -- something they can feel good about.”