Fearing pain and avoiding activities contribute to disability and chronic pain in kids with gut malady

March 17, 2014

New research from the University of North Carolina School of Medicine suggests that fear avoidance contributes to disability and pain in children with Functional Abdominal Pain (FAP) but not Inflammatory Bowel Disease (IBD).

When experience , they may either confront the pain or learn to fear pain and avoid certain activities. This behavior is termed fear-avoidance. Confronting the pain has been thought to lead to pain resolution while learned avoidance may persist and cause and disability that can disrupt normal childhood activities.

Researchers at the University of North Carolina School of Medicine and the University of Washington tested this fear-avoidance model of pain in 129 children with Inflammatory Bowel Disease (IBD) in remission and in 200 children with Functional Abdominal Pain (FAP; ages 8-18). In IBD pain is caused by gut inflammation and alternated with periods of disease remission. Pain can persist after inflammation has subsided. In FAP pain occurs in the absence of a specific cause. Thus, in both FAP and IBD patients in remission, no disease pathology explains the pain.

Miranda van Tilburg, PhD, associate professor of medicine in UNC's Division of Gastroenterology and Hepatology, is lead author of the study, which was presented Thursday, March 13, at the annual meeting of the American Psychosomatic Society in San Francisco.

"Chronic is very common among children," van Tilburg said. "How a child feels about and reacts to the pain is as important as the severity of pain in determining how much the pain will affect a child's life."

Evidence that fear and avoidance predict disability was found only in children with FAP. In these children, more was associated with increased catastrophizing (worrying about pain while feeling helpless to do anything about it). Catastrophizing in turn was associated with believing that pain is a threat, which was then associated with increased disability and pain.

Thus if children experience helplessness and a sense of threat in response to pain, they may become fearful of the pain, and avoid activities such as going to school or participating in sports. Over time the combination of fear and avoidance may lead to a heightened experience of pain and more disruption of normal activities.

Fear avoidance appears to contribute to disability and pain in children with Functional Abdominal Pain but not in children with Inflammatory Bowel Disease in remission.

"Children with FAP and IBD in remission are thought to have similar causes for their pain," van Tilburg said. "We hypothesized that fear avoidance would also have a similar influence on pain outcomes in both disorders, but this is not what we found."

Explore further: Childhood tummy aches may be tied to adult anxiety, depression

Related Stories

BMI not linked to pain after exercise rehab for back pain

December 12, 2013

(HealthDay)—For individuals with chronic low back pain (cLBP), body mass index (BMI) is not significantly associated with self-reported pain and disability, according to a study published in the Dec. 1 issue of Spine.

Oxytocin may treat abdominal pain

January 31, 2014

(Medical Xpress)—Australian researchers have found a key to treating chronic abdominal pain may lie in a hormone that induces labour and encourages social bonding.

Recommended for you

Cellphone data can track infectious diseases

August 20, 2015

Tracking mobile phone data is often associated with privacy issues, but these vast datasets could be the key to understanding how infectious diseases are spread seasonally, according to a study published in the Proceedings ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.