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Chronic abdominal pain is defined as persistent or recurrent episodes of abdominal pain (in the belly or stomach) lasting for more than three months. The abdominal pain may be caused by a specific disease like Crohn’s disease, or be due to a functional disorder.
Functional gastrointestinal disorders (such as irritable bowel syndrome and functional abdominal pain) are not explained by any identifiable structural or biochemical abnormalities – meaning doctors don’t know what cause them. Children with functional disorders often have a normal medical work up.
In a small number of children, abdominal pain is caused by an underlying, identifiable condition (e.g., Crohn’s disease). However, in most children, the pain has no identifiable cause. This does not mean that the pain isn't real.
Although the exact cause is unknown, nerve signals or chemicals secreted by the gut or brain may cause the gut to be more sensitive to triggers that normally do not cause significant pain (such as stretching, gas bloating or stress). Because of this change in bowel function, this type of abdominal pain is often referred to as “functional abdominal pain.”
Recurrent abdominal pain typically occurs prior to puberty, with two peaks of frequency. The first peak occurs between 5-7 years of age, with equal frequency in boys and girls and in 5-8% of children.
The second peak, occurring in nearly 25%, occurs between 8-12 years of age and is far more common in girls. The child often has a family history of functional bowel disease such as irritable bowel syndrome.
Chronic abdominal pain is vague pain located around the umbilicus (belly button). However, the pattern or location of abdominal pain is not always predictable with this condition. The pain may occur suddenly, or slowly increase in severity. The pain may be constant or may increase and decrease in severity.
Some children with chronic abdominal pain may experience dyspepsia, or upper abdominal pain associated with nausea, vomiting, and/or a feeling of fullness after just a few bites. Chronic abdominal pain can also be accompanied by involuntary features such as pallor, nausea, dizziness, headache and fatigue.
Children with abdominal pain will have completed a full work up by a gastroenterologist prior to a referral to the Chronic Pain Clinic at Children’s Hospital Colorado. Once the gastroenterologist refers a patient to our clinic, the focus becomes pain management.
Children who have been evaluated and treated by a gastroenterologist but still experience chronic abdominal pain that impacts their function or quality of life are often referred to our Chronic Pain Clinic. Here, they are evaluated by a multidisciplinary team of specialists (doctors, nurse practitioners, psychologists, social work, physical therapy and nursing) who are experts in the biopsychosocial model of pain.
Experts at the Chronic Pain Clinic understand the complex interplay of the biological, psychological, individual, social, and environmental factors that contribute to and maintain chronic abdominal pain symptoms and subsequent disability.
Each child and family seen in the Chronic Pain Clinic at Children’s Hospital Colorado is given an individualized plan to treat their chronic abdominal pain. The management of chronic abdominal pain in children takes into account the contribution of psychological factors, social factors and biological processes.
For all patients, the treatment begins with the acknowledgement that the pain is real, that ongoing, extensive medical evaluations are not warranted, and that the child should focus on a return to normal routine (e.g., school, continuing activities and resuming a normal diet).
The goal of managing chronic abdominal pain is to provide a satisfactory quality of life through education, medical interventions and better coping skills and support. Some children may benefit from medications, if chronic abdominal pain is significantly limiting the daily routine and quality of life. These medications include anti-spasmodic medicines, muscle relaxants and neuropathic agents. A child may also benefit from low doses of medicines called tricyclic antidepressants (used at much higher doses to treat depression), which can be excellent pain relievers for some children.
Some psychological treatments that help children cope with functional abdominal pain and other stressors include behavioral therapy, relaxation exercises and hypnosis.
The Chronic Pain Clinic at Children’s Colorado offers evidence-based care for children with chronic abdominal pain by using a multidisciplinary approach. Our clinic offers the ability to combine education, medical interventions, psychological therapies and support, physical therapy, and other integrative approaches such as acupuncture.
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Certified Pediatric Nurse Practitioner
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