Importance of Addressing Anxiety in Youth With Functional Abdominal Pain

Cunningham, N.; Lynch-Jordan, A.; Mezoff, Adam; Farrell, Michael; Cohen, Mitchell B.; Kashikar‐Zuck, Susmita

doi:10.1097/mpg.0b013e31828b3681

Cited by 37 publications

(44 citation statements)

References 73 publications

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“…Our findings continue to support research that indicates that clinically significant anxiety in patients with chronic pain is highly prevalent (18, 19, 31-33). The results of this investigation speak to the importance of anxiety screening in youth with chronic pain conditions in order to predict those patients who might be at greatest risk for poor outcomes - as they might respond less than optimally to standard pain-focused CBT.…”

Section: Discussionsupporting

confidence: 86%

Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain

Cunningham

Jagpal

Tran

et al. 2016

The Journal of Pediatrics

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Objective To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). Study design The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for Anxiety Related Emotional Disorders (SCARED) was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory [FDI]) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. Results Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F (1, 36) = 13.68 p < 0.01). A similar effect was observed for FDI, such that the group with clinical anxiety had a significantly smaller response to treatment (F (1, 38) = 4.33 p < 0.05). The differences in pain and disability between groups following CBT suggest moderate effects (Cohen’s d = 0.77 and 0.78, respectively). Conclusions Although youth with clinical anxiety are more likely to start and/or complete pain-focused CBT, anxiety has an adverse impact on CBT treatment response in children with chronic pain. Identification of patients with anxiety and use of tailored behavioral interventions may improve clinical outcomes.

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Section: Discussionsupporting

confidence: 86%

Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain

Cunningham

Jagpal

Tran

et al. 2016

The Journal of Pediatrics

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“…First, this investigation is a cross sectional study and therefore a true predictive model could not be tested. Second, other psychological variables such as a broad measure of child anxiety which have been shown to have a significant relationship to disability in youth with FAP (5) were not available for examination in the current study. However, it should be noted that pain catastrophizing can be considered a cognitive expression of anxiety, which reduces concern that a significant factor has been entirely overlooked.…”

Section: Discussionmentioning

confidence: 99%

Child Pain Catastrophizing Mediates the Relation Between Parent Responses to Pain and Disability in Youth With Functional Abdominal Pain

Cunningham¹,

Lynch-Jordan²,

Barnett³

et al. 2014

J. pediatr. gastroenterol. nutr.

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Objectives Functional abdominal pain (FAP) in youth is associated with substantial impairment in functioning and prior research has shown that overprotective parent responses can heighten impairment. Little is known about how a range of parental behaviors in response to their child’s pain (overprotection, minimizing and/or encouragement) interact with child coping characteristics (e.g., catastrophizing) to influence functioning in youth with FAP. In this study, it was hypothesized that the relationship between parenting factors and child disability would be mediated by children’s level of maladaptive coping (i.e., pain catastrophizing). Methods Seventy-five patients with FAP presenting to a pediatric pain clinic and their caregivers participated. Youth completed measures of pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and disability (Functional Disability Inventory). Caregivers completed measures of parent pain catastrophizing (Pain Catastrophizing Scale), and parent responses to child pain behaviors (Adult Responses to Child Symptoms: protection, minimizing, and encouragement/monitoring subscales). Results Increased functional disability was significantly related to higher child pain intensity, increased child and parent pain catastrophizing, and higher levels of encouragement/monitoring and protection. Parent minimization was not related to disability. Child pain catastrophizing fully mediated the relationship between parent encouragement/monitoring and disability and partially mediated the relationship between parent protectiveness and disability. Conclusions The impact of parenting behaviors in response to FAP on child disability is determined in part by the child’s coping style. Findings highlight a more nuanced understanding of the parent-child interaction in determining pain-related disability levels, which should be taken into consideration in assessing and treating youth with FAP.

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“…FGIDs are characterized by a high prevalence of anxiety 7–10 that adversely impacts disability in this population 11–14 even over the long term 12, 14–16 . For a 25–45% of affected youth, pain and impairment persist for five years or longer 17, 18 .…”

mentioning

confidence: 99%

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

Cunningham

Jagpal

Peugh

et al. 2017

J. pediatr. gastroenterol. nutr.

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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.

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Importance of Addressing Anxiety in Youth With Functional Abdominal Pain

Cited by 37 publications

References 73 publications

Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain

Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain

Child Pain Catastrophizing Mediates the Relation Between Parent Responses to Pain and Disability in Youth With Functional Abdominal Pain

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

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