Idiopathic abdominal pain in children: results, deficits and perspectives of empirical research

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Recurrent abdominal pain (RAP) is one of the most common pain syndromes in childhood, with prevalence rates ranging from 10 to 20% in all school-age children. In nearly 50% the complaints persist over many years of their life-span to adolescence or adulthood. Although the empirical findings have increased in the last decade, our knowledge about the etiology, pathogenesis, and pathophysiology is still very limited. Current approaches suggest that we understand recurrent pain syndromes as a complex and multidimensional disturbance (biopsychosocial paradigm). In this respect there is strong evidence for the major importance of psychosocial causes (daily hassles, specific life events), psychopathological factors (anxiety, depression, somatization disorder), and social environmental influences (mother's psychopathology, social modelling, reinforcement) in the pathogenesis of functional abdominal pain. The noticeable correlation with other pain syndromes and functional disturbances indicates that recurrent pain may possibly be a manifestation of a basic somatization disorder. The unfavourable long-term prognosis supports the need for early and specific interventions. Psychological treatment requires a medical examination to exclude organic origins. Some of these invasive diagnostic procedures can be very difficult, expensive and distressing for the child. Behavioural medicine is based upon having an extensive family history and symptom analysis. The psychological interventions applied in clinical practice include prophylaxis, reduction of pain symptoms and environmental modification. In recent years there has been an increasing trend to create more complex and multidimensional behavioural treatment programs for children. Although preliminary data on the use of these behavioural medicine programs have shown some promise, further investigations are needed to examine the applicability and effectiveness of specific interventions in the treatment of abdominal pain symptoms.