Benign Pain Research Articles

Internet-based cognitive behavioural therapy for insomnia comorbid with chronic benign pain – A randomized controlled trial

BackgroundComorbid sleep disturbances are common among individuals with chronic pain, and Cognitive Behavioural Therapy for Insomnia (CBT-i) has proven effective for such individuals. Nonetheless, research on web-based CBT-i tailored for patients with both chronic pain and insomnia is limited. This study aimed to evaluate the feasibility and efficacy of internet-based CBT-i and to explore potential mechanisms underlying treatment outcomes. MethodsIn this study, 85 participants suffering from comorbid insomnia and chronic pain were randomized into two groups: Internet-based CBT for Insomnia (ICBT-i) and Internet-based Applied Relaxation (IAR). Both interventions spanned eight weeks, supported by therapeutic guidance throughout. ResultsParticipation was modest, with an average module completion of 2.0 out of 8 for ICBT-i and 2.4 for IAR. Both interventions significantly alleviated insomnia symptoms post-treatment without notable differences between them. Directly after treatment, IAR outperformed ICBT-i in reducing pain interference, anxiety, and in enhancing self-rated health, though these differences lessened at the 6-month follow-up. Potential therapeutic mechanisms may involve attenuating maladaptive sleep beliefs and augmenting sleep-related willingness. ConclusionsThe study encountered low engagement rates, with approximately one-third of participants not completing any module. The limited efficacy of ICBT-i may be due to low treatment involvement, with few patients completing key techniques like sleep compression and stimulus control. Despite the low adherence, both interventions yielded post-treatment improvements in insomnia symptoms, but to establish internet-based treatments for insomnia as a viable option in chronic pain management, patient engagement must be improved.

Further Clarification of Pain Management Complexity in Radiotherapy: Insights from Modern Statistical Approaches.

The primary objective of this study was to assess the adequacy of analgesic care in radiotherapy (RT) patients, with a secondary objective to identify predictive variables associated with pain management adequacy using a modern statistical approach, integrating the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and the Classification and Regression Tree (CART) analysis. This observational, multicenter cohort study involved 1387 patients reporting pain or taking analgesic drugs from 13 RT departments in Italy. The Pain Management Index (PMI) served as the measure for pain control adequacy, with a PMI score < 0 indicating suboptimal management. Patient demographics, clinical status, and treatment-related factors were examined to discern the predictors of pain management adequacy. Among the analyzed cohort, 46.1% reported inadequately managed pain. Non-cancer pain origin, breast cancer diagnosis, higher ECOG Performance Status scores, younger patient age, early assessment phase, and curative treatment intent emerged as significant determinants of negative PMI from the LASSO analysis. Notably, pain management was observed to improve as RT progressed, with a greater discrepancy between cancer (33.2% with PMI < 0) and non-cancer pain (73.1% with PMI < 0). Breast cancer patients under 70 years of age with non-cancer pain had the highest rate of negative PMI at 86.5%, highlighting a potential deficiency in managing benign pain in younger patients. The study underscores the dynamic nature of pain management during RT, suggesting improvements over the treatment course yet revealing specific challenges in non-cancer pain management, particularly among younger breast cancer patients. The use of advanced statistical techniques for analysis stresses the importance of a multifaceted approach to pain management, one that incorporates both cancer and non-cancer pain considerations to ensure a holistic and improved quality of oncological care.

Clinical, laboratory characteristics and growth outcomes of children with growing pains

Growing pains (GP), a common and benign pain syndrome of unknown etiology, is characterized by bilateral recurrent leg pain in childhood. There are no standardized diagnostic criteria for GP, and the diagnosis is often made by exclusion. To identify clinical and laboratory features, we included patients < 12 years with GP at National Taiwan University Children’s Hospital between April 2006 and April 2019 in a retrospective study. We also compared body weight and body height z-scores between diagnosis and up to 2 years post-diagnosis to determine if rapid growth was associated with GP. This cohort study included 268 patients with a mean age of 4.7 ± 2.2 years. The most common features of GP were bilateral leg pain, no limitation of activity, intermittent pain, normal physical examination, and being well physically. The average number of Walters' criteria fulfilled by the patients with GP was 6.7 ± 0.9. Elevated serum levels of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were observed in 37.5% and 15.6% of patients, respectively. Symptomatic medications were used in 33% of patients. Our study indicates that ALP and LDH may be biomarkers associated with GP. There was no significant association between GP and rapid growth within 2 years of diagnosis.

Machine Learning and Pathway Analysis-Based Discovery of Metabolomic Markers Relating to Chronic Pain Phenotypes.

Recent scientific evidence suggests that chronic pain phenotypes are reflected in metabolomic changes. However, problems associated with chronic pain, such as sleep disorders or obesity, may complicate the metabolome pattern. Such a complex phenotype was investigated to identify common metabolomics markers at the interface of persistent pain, sleep, and obesity in 71 men and 122 women undergoing tertiary pain care. They were examined for patterns in d = 97 metabolomic markers that segregated patients with a relatively benign pain phenotype (low and little bothersome pain) from those with more severe clinical symptoms (high pain intensity, more bothersome pain, and co-occurring problems such as sleep disturbance). Two independent lines of data analysis were pursued. First, a data-driven supervised machine learning-based approach was used to identify the most informative metabolic markers for complex phenotype assignment. This pointed primarily at adenosine monophosphate (AMP), asparagine, deoxycytidine, glucuronic acid, and propionylcarnitine, and secondarily at cysteine and nicotinamide adenine dinucleotide (NAD) as informative for assigning patients to clinical pain phenotypes. After this, a hypothesis-driven analysis of metabolic pathways was performed, including sleep and obesity. In both the first and second line of analysis, three metabolic markers (NAD, AMP, and cysteine) were found to be relevant, including metabolic pathway analysis in obesity, associated with changes in amino acid metabolism, and sleep problems, associated with downregulated methionine metabolism. Taken together, present findings provide evidence that metabolomic changes associated with co-occurring problems may play a role in the development of severe pain. Co-occurring problems may influence each other at the metabolomic level. Because the methionine and glutathione metabolic pathways are physiologically linked, sleep problems appear to be associated with the first metabolic pathway, whereas obesity may be associated with the second.

Punctate Midline Myelotomy: A Historical Overview and Case Series with Detailed Efficacy and Side Effect Profiles

To review our experience with punctate midline myelotomy (PMM) for malignant and benign visceral pain with an emphasis on detailed side-effect profiles and efficacy. Thirteen adults (5 men) underwent microsurgical transverse-crush PMM. Median follow-up for the benign pain group (n= 6) was 17.5 months (10-72) and for the malignant group (n= 7) was 8 months (0.5-31). Five of seven patients in the malignant pain group obtained excellent, lasting relief. Two had initial relief followed by worsening pain with disease progression. In the benign pain group, two patients with endodermal-origin pain (gastrointestinal tract, bladder) had complete, long-lasting relief. Three patients with mesodermal-origin pain (ureter) had excellent relief for 2-3 months, followed by recurrence in two and partial (40%) recurrence in the third. One man with pre-existing cervical myelopathy underwent PMM for benign testicular-region pain from which he had long-term relief but only transient relief of coexisting low-back and leg pain. There were no motor deficits in either group, and all patients remained ambulatory and continent. The most common side effect was transient numbness of the medial leg and foot. Two patients (both with pre-existing spinal pathology) reported persistent moderate reduction of bowel, bladder, and sexual sensation. PMM offers substantial pain relief for carefully selected patients with intractable visceral pain. Relief from primarily endoderm-derived structures was most complete and long-lasting. Relief from mesoderm-derived structures was typically transient or incomplete. There was essentially no relief from pain of ectoderm-derived structures. Detailed preoperative counseling is important, especially for those with pre-existing neurologic deficits.

Working Out Your Pain: Why Intense Exercise Is Painful

When it comes to experiencing pain, most people will agree that it is an uncomfortable sensation that we would rather avoid. Pain can vary in intensity—ranging from the mild sensation of stubbing your toe to the intense pain of a broken bone—and we generally think of it as a bad thing. But pain can be thought of in two ways: sometimes it is a warning signal that something is wrong with our bodies, but other times it is benign, meaning it is not an indication that something is necessarily wrong. Warning-signal pain occurs when certain areas of your body get hurt or experience tissue damage, like when a sibling accidentally closes the car door on your fingers. Benign pain, on the other hand, is the type of pain you feel during intense physical exercise, and as you will come to see, is not always something you need to avoid!

Оптимізація терапії у пацієнтів з болем в нижній частині спини в залежності від наявності синдрому доброякісної гіпермобільності суглобів

Оптимізація терапії у пацієнтів з болем в нижній частині спини в залежності від наявності синдрому доброякісної гіпермобільності суглобів

Audit of patients of the pain clinic of the University Hospital of Heraklion with neuropathic pain during the period 2019–2020

Introduction: Neuropathic pain is caused by a lesion or disease of the somatosensory system and affects 7–10% of the population [1–3]. The aim of this study was the analysis of patients referred with neuropathic pain to the University Hospital of Heraklion pain clinic (2019–2020) in terms of characteristics, underlying disease, treatment and response to treatment. Methods: Patients diagnosed with neuropathic pain (Pain Detect questionnaire) were recruited. Pain intensity was assessed using NAS. Data were in the form of qualitative or quantitative variables and were expressed as frequencies and % frequencies. The x2 test was used to detect statistically significant differences in percentages or correlations between the categorical variables. Statistical analysis was performed using IBM SPSS Statistics 26.0 (IBM Corp., Chicago, IL, USA). Acceptance limit was set to α = 0.05. Results: 120 patients (age 64.0 ± 15.1 years, men 55.8%, cancer history 50%) were included. Merely neuropathic pain occurred in 43.3% of patients. Patients were allocated into two groups: benign pain group —with herpes zoster (23%) and spine diseases (14%) as the most frequent causes—and malignant pain group (mainly due to gynaecological, breast or lung cancer). The groups did not differ in the main symptoms—burning (46.7%), allodynia (23.3%), hyperalgesia (28.3%)—nor in the pain location (most often in lower extremities and pelvis). Both groups experienced sleep disorders—poorer sleep quality in malignant pain (36.7% vs 16.7%)—and poor psychological state (33.9% in benign, 28.8% in malignant pain). NSAIDs use was more common in benign (58.3% vs 15.9%, p 30% following initial treatment and a corresponding reduction in further modification. Conclusions: Most patients with neuropathic pain were >50 years old, reported a burning sensation and experienced effects on quality of life (quality of sleep, psychological state).

Health complaints and work experiences among adults with neurofibromatosis 1.

Neurofibromatosis type 1 (NF1) is a rare genetic disorder with usually benign nerve tumours, skin problems, pain and cardiovascular problems among common complications. To examine work participation and experiences in relation to health complaints among adults with NF1. We conducted a cross-sectional self-reported survey among 142 persons with NF1 (mean age = 50.3 years, SD = 12.0; 62% females). We measured physical and social dimensions of work experiences with eight items from the third wave of the epidemiological survey 'Nord-Trøndelag Health Study' (HUNT3). We compared NF1 data to 27 036 HUNT3 controls. We measured health complaints with the 29-item Subjective Health Complaints Inventory (SHC; subscales musculoskeletal pain, pseudoneurology and gastrointestinal problems) and compared NF1 data to norms. Compared to controls, significantly more persons with NF1 reported workplace bullying (13% versus 5%) and work as physically exhausting (74% versus 44%), whereas fewer reported work autonomy (64% versus 80%). Women with NF1 reported significantly more SHC than female norms (99% versus 86%). Men with NF1 reported significantly more pseudoneurology and gastrointestinal problems compared to male norms (76% versus 58%). SHC explained 9% of the variance in physical work experiences (β = -0.47; 95% CI -0.76 to -0.19) and 8% of the variance in social work experiences (β = 0.48; 95% CI 0.18-0.78). Persons with NF1 experience more physical and social work problems, and both work domains were related to health complaints. Individualized assessment and information to co-workers and managers may represent ways to increase work participation among persons with NF1.

Wachstumsschmerzen

Leg pain is a common reason for consultation in the children's orthopedic clinic. It can occur across all age groups, although most patients are of pre-school or elementary school age. As there are a series of possibly severe differential diagnoses that might cause such pains in children and adolescents apart from benign pains that occur in the context of growth, a thorough patient history and physical examination are essential. Despite extensive research, the cause of benign growing pains has not been elucidated so far. Several possible factors play a role on an anatomical, metabolic or functional basis, ; thus, various theories exist with regard to their origin. Growing pains constitute adiagnosis of exclusion. If a possible organic cause of the pains is suspected, an extended diagnosis of the person affected should be made. Growing pains primarily occur at night and are always self-resolving. With regard to treatment, mild pain medications can be employed in more severely affected patients. It is much more important to inform family members about the benign nature of the condition. Reassuring words and physical relaxation exercises, in addition to massaging and stretching of the leg muscles, can cause asignificant reduction in pain without medication.

Case 5: Chest Pain and Elevated Troponin in a Teenager

1. Benson S. Hsu, MD, MBA* 2. Mary Guillot, MD* 3. Jennifer Mosher, MD† 4. Theresa Stamato, MD* 1. *Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 2. †Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND A 16-year-old boy presents to a local emergency department with the acute onset of chest pain. He describes the pain as sharp, stabbing, and directly over his sternum with radiation to his back. Before this presentation, he had 1 week of upper respiratory and gastrointestinal symptoms, including cough, rhinorrhea, and diarrhea. Physical examination reveals a nontoxic-appearing teenager with a temperature of 98.06°F (36.7 ° C), heart rate of 93 beats/min, respiratory rate of 23 breaths/min, blood pressure of 116/65 mm Hg, and oxygen saturation of 96% in room air. His height is 66 in and weight is 66.4 kg for a body mass index of 23.5. His cardiac examination documents regular rate and rhythm and no murmurs, rubs, or gallops. His respiratory examination reveals good air entry throughout without wheezing or crackles. Capillary refill is at 2 seconds, and he has warm and well-perfused extremities. Abdominal examination findings are benign and sternal pain is noted at the xiphoid process. In the emergency department, his chest pain improves with treatment directed at gastroesophageal reflux. …

Development of new extra-glandular manifestations or associated auto-immune diseases after establishing the diagnosis of primary Sjögren's syndrome : A long-term study of the Antonius Nieuwegein Sjögren (ANS) cohort.

To investigate in a long-term study, the development of new extra-glandular manifestations (EGM) or associated auto-immune diseases (AID) from 1 year after establishing the diagnosis of primary Sjögren's syndrome (pSS). The primary goal was to examine the frequency and type of these manifestations and to find out which demographic, clinical and serological profile was most at risk. All outpatients diagnosed with primary Sjögren's syndrome were included in a retrospective study, with at least one check-up per year, from June 1991 until August 2015. Patients also fulfilling the criteria for concomitant connective tissue disorders were excluded. Data were collected with respect to the cumulative prevalence of a new EGM or associated AID. 140 patients were included in the final analysis. After 10 years of follow-up, the cumulative incidence of a new EGM or associated AID was 30.7%. The most frequent events were polyneuropathy, interstitial lung disease, (poly)arthritis, discoid lupus erythematosus (LE)/subacute cutaneous LE and Hashimoto's disease. Non-Hodgkin lymphoma was not diagnosed during the follow-up. Patients without chronic benign pain syndrome (CBP) (HR 2.13; 95% CI [0.94-4.76]; p=0.061), but in particular those with cryoglobulins (HR 2.87; 95% CI [1.20-6.86]; p=0.013), developed more events. Age at diagnosis, gender, the presence of ANA, anti-Ro/SSA, anti-La/SSB, IgM-RF, decreased levels of C3 or C4, or hypergammaglobulinaemia did not show any statistically significant differences. The burden of disease in pSS is higher than expected due to the development of EGM or associated AID. Therefore, we recommend long-term follow-up of all pSS patients, particularly those with cryoglobulinaemia.

P266 Efficacy of transcranial Direct Current Stimulation (tDCS) in somatic symptom disorder, predominantly pain: A randomized, double-blind, sham-controlled study

Introduction Chronic benign pain is a symptom which contributes significantly to morbidity and causes considerable distress affecting various domains in a patient’s life. There is a growing need to address this issue for a safer and a better therapeutic intervention. tDCS is a non-invasive tool that has been found to have therapeutic efficacy in pain syndromes. Objectives To study the changes in pain severity, somatoform symptoms severity and global illness severity with adjuvant tDCS in Somatic Symptoms Disorder as compared to sham stimulation. Materials and methods We investigated in a prospective hospital-based, randomized, double-blind, sham-controlled trial the analgesic effects of a 5 day treatment of anodal (tDCS) with 2 mA current for 40 min duration over the primary motor cortex in Somatic Symptom Disorder, predominantly pain. 26 subjects were assessed on Visual Analogue Scale (VAS) for pain at baseline, at end of 5th day and end of 30 days; somatoform symptom severity and global illness severity were also measured using Quantification inventory for somatoform syndromes (QUISS) scale and Clinical Global Impressions (CGI) at baseline and on follow up of 30 days. Patients were also assessed on WHOQoL-BREF at baseline and on follow up of 30 days for quality of life. Results VAS Scores showed significant change as compared to sham group (Pillai’s Trace F = 74.32, p Conclusion Our findings give preliminary evidence that tDCS of the primary motor cortex is safe and effective for somatoform pain symptoms. These effects may be related to electrical currents induced in pain-related cortical and subcortical regions.

Repeated Quantitative Urine Toxicology Analysis May Improve Chronic Pain Patient Compliance with Opioid Therapy

Background: Even though serious efforts have been undertaken by different medical societies to reduce opioid use for treating chronic benign pain, many Americans continue to seek pain relief through opioid consumption. Assuring compliance of these patients may be a difficult aspect of proper management even with regular behavioral monitoring. Objective: The purpose of this study was to accurately assess the compliance of chronic opioidconsuming patients in an outpatient setting and evaluate if utilizing repeated urine drug testing (UDT) could improve compliance. Study Design: Retrospective analysis of prospectively collected data. Setting: Outpatient pain management clinic. Methods: After Institutional Review Board (IRB) approval, a retrospective analysis of data for 500 patients was conducted. We included patients who were aged 18 years and older who were treated with opioid analgesic medication for chronic pain. Patients were asked to provide supervised urine toxicology specimens during their regular clinic visits, and were asked to do so without prior notification. The specimens were sent to an external laboratory for quantitative testing using liquid chromatography-tandem mass spectrometry. Results: Three hundred and eighty-six (77.2%) patients were compliant with prescribed medications and did not use any illicit drugs or undeclared medications. Forty-one (8.2%) patients tested positive for opioid medication(s) that were not prescribed in our clinic; 8 (1.6%) of the patients were positive for medication that was not prescribed by any physician and was not present in the Illinois Prescription Monitoring Program; 5 (1%) patients tested negative for prescribed opioids; and 60 (12%) patients were positive for illicit drugs (8.6% marijuana, 3.2% cocaine, 0.2% heroin). Repeated UDTs following education and disclosure, showed 49 of the 77 patients (63.6%) had improved compliance. Limitations: This was a single-site study and we normalized concentrations of opioids in urine with creatinine levels while specific gravity normalization was not used. Conclusions: Our results showed that repeated UDT can improve compliance of patients on opioid medications and can improve overall pain management. We believe UDT testing should be used as an important adjunctive tool to help guide clinical decision-making regarding opioid therapy, potentially increasing future quality of care. Key words: Urine toxicology analysis, chronic pain, opioids, compliance, pain management, urine drug testing, urine drug screening

A Rare Cause of Chest Pain Mimicking Coronary Artery Disease

Chest pain accounts for 6% of emergency room presentations (1). Differential diagnosis of chest pain ranges from benign pain arising from musculoskeletal system to the malignant reasons that may be fatal unless diagnosed and treated promptly such as myocardial infarction and aortic dissection. It is difficult to exclude cardiovascular causes of chest pain in the patients with atherosclerotic risk factors even chest pain is atypical, and coronary angiography may become obligatory to exclude myocardial ischemia. Herein, we present seven patients, who presented to the cardiology clinic of our hospital with chest pain, in whom coronary angiography has become obligatory for the exclusion of myocardial ischemia, and of whom further examinations after exclusion of myocardial ischemia revealed thoracic schwannoma.

Patient expectations for a multimodal pain rehabilitation programme: active participation and coping skills. A qualitative study

Purpose: To describe what patients with chronic pain expect from a multimodal pain rehabilitation programme.Material and method: Qualitative interviews were used to uncover expectations about a multimodal rehabilitation programme offered at the Pain and Rehabilitations Centre, The University Hospital; Linköping, Sweden. Sixteen women and two men (mean age 37 years; standard deviation 10 years) with chronic benign pain participated. The interviews were analysed using qualitative content analyses.Results: To participate actively in the multimodal pain rehabilitation programme and to learn adequate coping strategies to improve daily life emerged as a main category. It was based on the following four categories comprising expectations about: participating actively in the programme, interacting with the professionals and fellow patients, cognitive effects of the programme and tools for coping, and explicit effects from the programme.Conclusions: Many patients expressed expectations which may reflect that the information before the programme had started rehabilitation process at the time point for this study. The results could be applied in rehabilitation programmes by acknowledging expectations to interact with professional team members and fellow patients, by early addressing of positive and negative expectations about the future pain and by incorporating and strengthen expectations of learning to cope with pain.Implications for RehabilitationPatients' expectations to interact with professional team members and fellow patients by participating actively in the pain rehabilitation programme should be acknowledged in each rehabilitation situation.Patients expressed both positive and negative expectations about their future pain situation and these expectations should be addressed as early as possible in the rehabilitation screening process.Patients' expectations of learning to cope with pain should be incorporated and strengthened in multimodal pain rehabilitation programmes.

OC-077 The short term outcomes from 2468 bariatric procedures: a single centre of excellence

Introduction Bariatric surgery is associated with long-term weight loss and decreased overall mortality. 1 The development of the ‘Centre of Excellence’ model has seen improvements in bariatric outcomes. 2 We wish to publish the short-term results from a single Centre of Excellence in Australia. Method A database of 2468 patients was retrospectively created between 2010 and 2013. All patients underwent laparoscopic sleeve gastrectomy (LSG) (n = 1642), laparoscopic gastric band (LGB) (n = 554) and laparoscopic gastric bypass (LRYGB) (n = 272). The primary endpoint was overall mortality. The secondary endpoints were leak rate, length of hospital stay, readmission rates and complication rates. Results There were no deaths. There were a total of 9 leaks (LSG-5; LGB-4; 0.36%). The median lengths of stay for LSG, LGB and LRYGB were 3 days, 3 days and 1 day respectively. There were a total of 77 unplanned readmissions for 64 patients (readmission rate 3.1%). 31 readmissions (40.3%) were for dehydration and 14 (18.2%) were for benign abdominal pain. Twenty-four patients were taken back to theatre for complications on 30 occasions (0.97%; LSG-11, LRYGB-9, LGB-4). Ten (33.3%) take back procedures were in revision cases (LSG-1; LRYGB-7; LGB-2). Conclusion Bariatric surgery can be performed safely with a satisfactory short term morbidity profile in high-volume centres. Disclosure of interest None Declared. References Sjostrom L, Narbro K, Sjostrom CD, et al . Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52 Gebhart A, Young M, Phelan M, Nguyen NT. Impact of accreditation in bariatric surgery. Surg Obes Relat Dis. 2014;10:767–773

Adaptation to chronic benign pain in elderly adults.

This study sought to comprehend and analyze the experience of living with chronic benign pain during aging from the perspective of the adaptation model by Callista Roy. Ours was an exploratory descriptive study using for analysis tools from the theory based on criteria by Strauss and Corbin. The strategy involved in-depth interviews of 10 elderly adults residing in Medellín, Antioquia, and Chía, Cundinamarca (Colombia) with chronic benign pain. In elderly adults, behaviors were identified that were secondary to the presence of pain and which are consequence of the capacity to adapt to their experience, managing to modify the environment by using internal and external resources that permitted their controlling the pain-generating stimuli in the human beings adaptation means based on the Adaptation model by Callista Roy. Elderly adults respond effectively to their new secondary condition: presence of benign pain in all the means of adaptation.

Adaptation to chronic benign pain in elderly adults.

Adaptation to chronic benign pain in elderly adults.

PO-0908 External Influences On Paediatric Abdominal Pain: A Holistic View May Help

Introduction Abdominal pain should always be treated as aserious complaint by the clinician due to the large proportion of potentiallyserious medical conditions which can present with abdominal pain. However, a large proportion of children will not haveany significant disease processes underway. This study focuses on extrinsicfactors which may be associated with abdominal pain presentations to helpelucidate appropriate management. Methods Prospective study. A survey was administered to children and their parents, presenting tocasualty for assessment of abdominal pain. Questions related to thepatient and their family. Information obtained related to the child’shealth, social/family dynamics and family history wereobtained. Results 97 surveys were conducted. There was an equal sex distribution. Mean age was11. The three most common diagnoses were of Benign pain, Mesenteric adenitisand Appendicitis. There was a peak in winterpresentations for those with benign pain. 27% of children with benign pain had parentswho smoked. Inflammatory conditions were common with 38% and 28% of children,having family histories of asthma and eczema respectively. 9% had a history of IBS and Coeliac disease. Nodifferences between the sexes were observed. Conclusion Children presenting to hospital with abdominal pain have a higher prevalence ofparental smoking, eczema, asthma and migraine. There is a peak incidence inbenign presentations during winter. Even in children with significantextrinsic influences, appendicitis was the third most common diagnosis, mandating thorough evaluation for all children with abdominal pain nomatter the background circumstances.