Recurrent abdominal pain in children with cystic fibrosis: A pilot prospective longitudinal evaluation of characteristics and management

Abstract

Children with cystic fibrosis commonly experience abdominal pain; however this remains poorly characterised. This prospective cross-sectional study with a longitudinal design, examined the prevalence, causes and effect of pain management via daily diaries, validated questionnaires for pain characteristics, anxiety status and quality of life. One hundred and thirty CF patients aged 8 to 18 years, regularly followed at our centre, were questioned on recurrent abdominal pain. Eight patients fulfilled the criteria; all wished to enter the study. Pain management included behavioural intervention with effective pain relief, and had a positive impact on anxiety and quality of life. This study is the first one to prospectively assess recurrent abdominal pain in CF. We documented a very low prevalence of 6%. We suggest that, ruling out abdominal discomfort, only a minority of CF children presented recurrent abdominal pain with a true negative impact on daily life. We emphasise the need for further studies including larger cohorts.

Abdominal symptoms in cystic fibrosis and their relation to genotype, history, clinical and laboratory findings

“…To some extent, this may be explained by an overlap with some symptoms associated with the menstruation cycle. In accordance, significantly more abdominal pain has been described both in CF and in healthy pubescent girls [14,41]. Of note, our study revealed no differences in the overall abdomen scores between the age groups.…”

“…By comparison, Munck et al [14] reported a very low prevalence of recurrent abdominal pain (RAP) of 6%, yet using the more strict Apley’s criteria (at least three bouts of pain, severe enough to affect one´s activities, over a period of not less than three months, with attacks continuing in the year preceding the examination) [37]. In our study, the mean abdominal pain intensity was indicated as moderate (3 VAS pts; median = 4/max = 10) and of relatively short duration (<45 min), which is in the range of previous reports [8,10].…”

“…It has been recognized that abdominal symptoms relevantly impair health related quality of life (HRQoL) by affecting CF patients' daily activities as well as their emotional, social and physical functioning [13]. Yet, only one study focused on reporting prevalence of recurrent abdominal pain in CF [14]. …”

The Association Between Pain and Clinical Outcomes in Adolescents With Cystic Fibrosis

“…7,8 Using daily diaries, Blackwell and Quittner found that 76% of adolescents had episodes of pain. 10 In contrast, a study by Munck et al 25 found a very low incidence (6%) of recurrent abdominal pain in children with CF. At face value, this may appear to be entirely inconsistent with our findings and those of others, but the study by Munck used a strict definition of recurrent abdominal pain, ''at least three bouts of pain, severe enough to affect activities, over a period of not less than three months, with attacks in the year preceding the examination,'' which may explain the differences.…”

Daily pain in adolescents with CF: Effects on adherence, psychological symptoms, and health‐related quality of life

“…The high prevalence of abdominal pain in this study indicated the need to develop effective tools to assess this type of pain and interventions to treat it. A recent study by Munck and colleagues (2012) also documented recurrent abdominal pain in patients with CF and they were the first to develop a behavioral intervention to treat these symptoms . Results were promising and indicated a need for implementation of behavioral treatments to address pain.…”