Risk Categorization Predicts Disability in Pain‐associated Functional Gastrointestinal Disorders After 6 Months

Abstract

Introduction For a large portion of youth, pain-associated functional gastrointestinal disorders (FGIDs) are associated with significant impairment over time. Clinically feasible methods to categorize youth with FGIDs at greatest risk for persistent pain-related impairment have not yet been identified. Methods Measures of functional disability, pain intensity and anxiety were collected on 99 patients with FGIDs (ages 8–18) during a visit to a pediatric gastroenterology office to assess for the presence of risk. Follow-up data was obtained on a subset of this sample (n=64) after 6 months, either in person or via mail. This study examined whether a greater number of risk factors at baseline predicted greater pain-related disability at follow-up. Results Patients were divided into 4 groups based on number of risk factors present at the initial assessment: zero (18.2%) one (24.2%), two (26.3%), and three (31.3%). The presence of 2 or 3 risk factors significantly predicted greater disability at follow-up compared to those with 0 risk factors (R2= 0.311) and those with just 1 risk factor (Cohen’s d values of −1.07 and −1.44, respectively). Discussion A simple approach to risk categorization can identify youth with FGIDs who are most likely to report increased levels of pain-related impairment over time. These findings have important clinical implications that support the utility of a brief screening process during medical care to inform referral for targeted treatment approaches to FGIDs.

The Influence of Caregiver Distress and Child Anxiety in Predicting Child Somatization in Youth with Functional Abdominal Pain Disorders

“…We also found that increased child anxiety was related to higher levels of child functional disability. Our finding is consistent with previous research demonstrating that anxiety symptoms in pediatric FAPD are associated with pain-related disability [18,28,29]. Indeed, youth with recurrent abdominal pain conditions such as FAPD show decreased participation in daily activities (e.g., school attendance decreases, less participation in hobbies, etc.…”

“…Total scores range from 0 to 82, with higher scores reflecting greater levels of anxiety. A score of 25 or greater is considered clinically elevated anxiety, and elevated SCARED scores, in general, are associated with increased pain and disability in youth with FAPD [28,29]. The internal consistency of the SCARED for the current sample was 0.94, which is considered excellent.…”

“…This work expands upon our prior study which found that child pain catastrophizing mediates the association between caregiver responses to pain (particularly caregiver encouragement of child symptoms) and functional disability in youth with FAPD conditions [19] in several ways. This was accomplished by: (1) exploring caregiver mental health versus caregiver responses to child symptoms, the prior of which is known to be associated with poor mental health and health-related outcomes of youth [11], (2) studying the role of child anxiety versus child pain catastrophizing as a potential mediator, which is important given that child anxiety is associated with higher pain and pain-related disability in youth with FAPD both in cross-sectional investigations [27,34], and over the long-term [28], and is associated with poorer response to pain-focused psychological interventions [30] and (3) specifically examining how both caregiver anxiety and child anxiety impacts child somatization, which is a detrimental outcome of FAPD [6,13,14].…”

“…The current study expands upon this work by examining relationships between distress of the primary caregiver, child anxiety, and child FAPD-related outcomes. Studying youth with FAPD diagnoses is clearly representative of youth receiving care at GI subspecialty clinics [28] and therefore the results are clinically meaningful.…”

“…A prior study from our research laboratory found that child anxiety thoughts specific to pain (i.e., pain catastrophizing) mediated the association between parent responses to their child's pain and child functional disability in youth presenting to a pediatric pain clinic with FAPD conditions [19]. However, the influence of these factors on child somatization was not explored, nor was the role of child anxiety more broadly examined as a predictor of pain and pain-related disability in youth [27][28][29]. It is important to study the role of child anxiety in culmination with caregiver anxiety because our research group has consistently found that general child anxiety is associated with increased pain and disability and poorer treatment response [30].…”