Predictors of Chronic Abdominal Pain Affecting the Well-Being of Children in Primary Care

Abstract

PURPOSE Abdominal pain is a frequent symptom among children but is rarely associated with organic disease. Although it may persist for years, no factors have been identified that predict its prognosis. Our aim was to determine whether patient characteristics at initial consultation can predict chronic abdominal pain severe enough to influence the child's well-being at 1 year of follow-up. METHODSWe conducted this prospective cohort study in primary care, including consecutive children aged 4 to 17 years seen for abdominal pain by their family physician. Multivariate logistic regression analysis was used to identify prognostic factors that predicted chronic abdominal pain 1 year later. Discriminative ability of identified predictors was assessed using the area under the receiver operating characteristic curve and explained variance. RESULTSThe risk of having chronic abdominal pain at 1 year of follow-up was 37.1% in the cohort overall. Increasing age, waking up at night with pain, high levels of other somatic complaints, and chronic abdominal pain at baseline independently predicted chronic abdominal pain at 1 year. These predictors had a poor to moderate discriminative ability, however; the area under the receiver operating characteristic curve was only 0.69, and the predictors collectively explained only 14.3% of variance in the development of chronic abdominal pain. The absolute risk ranged from 19.4% among children having none of the predictors to 65.5% among children having 3 or 4 predictors.CONCLUSIONS Chronic abdominal pain sufficient to affect well-being is common among children initially seen for abdominal pain by family physicians. Although the risk of this outcome increases with number of predictors, these predictors are of limited value in identifying children in whom pain will become chronic, suggesting that other, as yet unidentified factors play an important role. Ann Fam Med 2015;13:158-163. doi: 10.1370/afm.1736. INTRODUCTIONA bdominal pain in children accounts for about 5% of childhood consultations in general practice in the Netherlands, 1 which is in agreement with studies performed in Australia and the United States reporting similar numbers of 2% to 4%.2,3 Most cases are considered medically unexplained and are labeled as functional abdominal pain (FAP). 4 In 10% to 15% of schoolchildren, abdominal pain persists or returns regularly, which increases health care use and has implications for the child's well-being in that they have poorer school attendance, withdraw from social activities, and show impaired physical abilities. [5][6][7] One in 3 children with chronic FAP continues to experience this pain for at least 5 years, underscoring the burden of disease. 8 In addition, childhood FAP has been linked to functional gastrointestinal (GI) disorders in adulthood, such as irritable bowel syndrome. [9][10][11][12][13] Despite evidence that childhood FAP may persist for years, few factors have been identified that predict whether it interferes with the child's wellbeing. 13 Recently, a h...

Predictors of treatment outcome in children with medically unexplained pain seeking primary care: A prospective cohort study

“…These numbers are higher than the prevalence of chronic pain in the German epidemiological sample, which reported a prevalence rate of 33% based on the same chronic pain definition (Häuser, Schmutzer, Hinz, Hilbert, & Brähler, ). However, in line with a Dutch study on recurrent abdominal pain (Spee et al, ), our results indicate that parental pain is not a risk factor for treatment failure in a child receiving primary care due to medically unexplained pain. While it is known that parental cognitions and behaviour have significant impact on a child’s pain experience (Feinstein et al, ; Poppert Cordts, Stone, Beveridge, Wilson, & Noel, ), these cognitions and behaviour may not be necessarily associated with parental chronic pain.…”

“…Demographic characteristics were not predictive. This is partially in line with results from the Dutch primary care study of children with recurrent abdominal pain (Spee et al, ), in which sex was not associated with treatment outcome, but older children were more likely to have ongoing pain. In our study, no child with a migration background visiting a doctor for the first time due to pain developed disabling chronic pain.…”

“…medically unexplained pain, in children presenting to primary care is limited. So far, only one research project explored children seeking primary care due to recurrent abdominal pain (Lisman‐van Leeuwen, Spee, Benninga, Bierma‐Zeinstra, & Berger, ; Spee et al, , ). In this study from the Netherlands, 90% of patients had medically unexplained pain (Spee et al, ) and nearly 40% experienced chronic abdominal pain 12 months after their initial visit (Lisman‐van Leeuwen et al, ).…”

“…In this study from the Netherlands, 90% of patients had medically unexplained pain (Spee et al, ) and nearly 40% experienced chronic abdominal pain 12 months after their initial visit (Lisman‐van Leeuwen et al, ). A variety of parameters predicted treatment outcome: older children, as well as those with chronic abdominal pain at the initial visit, those with other somatic complaints and those waking up at night due to pain had an increased risk of persistent chronic pain (Spee et al, ). However, these factors had only a low predictive ability.…”

Functional Gastrointestinal Disorders: All Roads Lead to Prevention

“…A recent study found that more than onethird of children with recurrent abdominal pain continued to complain of pain 1 year after starting treatment. 13 More than 40 years earlier, Apley and Hale 14 reported that one-third of children with recurrent abdominal pain continued to experience symptoms into adolescence. The comparison of outcomes from these 2 studies performed 4 decades apart is disheartening.…”