Recurrent Abdominal Pain

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What is it?

Recurrent (functional) abdominal pain is a common difficulty where children and young people experience frequent bouts of stomach pain over an extended period of time. The word ‘functional’ means that there is no physical disease, blockage, infection or inflammation causing the pain. Physical examination and sometimes, if necessary, further testing will have been used to make sure there is nothing wrong that needs medicines to treat it. Because there is no physical cause, medicines are not usually helpful in preventing or reducing the pain.

Nonetheless the young person is experiencing pain, which can be very distressing and limit everyday activities. Functional abdominal pain is relatively common in young people. The pain can
be long-lasting and described as recurrent or chronic abdominal pain. Your brain has a huge effect on your stomach. For example, when you are nervous you can feel like you have butterflies in your stomach. These are real feelings but there are no actual butterflies.

Your brain not only sends messages to your stomach that control how it works, it also receives messages from your stomach that it has to read and decide how to respond to. This is called the gut
brain axis. If the way your brain and stomach talk to each other is disrupted, you can get abdominal pain, diarrhoea and bloating even though there is no infection or a disease causing these symptoms. We may not be able to pinpoint exactly why this started but there are common triggers and factors that contribute to ongoing episodes of pain, including:

– After a viral or bacterial illness that has now got better.
– Diet. Do you get worse pain after eating certain foods? Talk to the doctor or dietitian before cutting anything out of your diet.
– Medications. Tell your doctor about all medicines you are taking including herbal or homeopathic.
– Stress or worry:
o School work
o Difficulties with friends or family
– Other people’s response to pain

How to get better
Your brain is hugely powerful and the key to getting better from functional abdominal pain. You need to retrain it to think and act in a positive and useful way. Below are starting points and links to other resources. Your doctor may feel a referral to a psychology team would be helpful.

Coping skills:
• Relaxation: breathing exercises, mindfulness
• Distraction
• Graded return to activities

Useful resources:

What parents and carers can do:
• Minimise attention given to nonverbal pain behaviour as this helps the child to focus on other things
• When pain is reported, acknowledge it and support the child or young person with strategies to distract and continue with activities.
• Reinforce ‘well behaviour’ by praising participation in activities

Input from the tertiary gastroenterology team at the John Radcliffe hospital including Dr Lucy Howarth (consultant) and Dr Camilla Holden (psychology). Archives of disease in childhood volume 102 issue 3. Practical management of functional abdominal pain in children. L K Brown. R M Beattie. M P Tighe.

Up to date 6/Oct/2018 Functional abdominal pain in children and adolescents: Management in primary care.

Mariam R Chacko, MD
Eric Chiou, MD

Section Editors:
Amy B Middleman, MD, MPH, MS Ed
Jan E Drutz, MD

Deputy Editor:
Mary M Torchia, MD