Researchers evaluated about 330 children with functional abdominal pain syndrome (FAPS) — abdominal pain with no specific cause — and compared them with 150 children without stomachaches.
Later psychiatric evaluations (conducted an average of nine years later) revealed that the risk of developing an anxiety disorder was about four to five times higher in individuals who suffered from abdominal pain as a child.
The findings also suggest that children with abdominal pain have a greater risk of adult depression. In the study, 40 percent of adults who had abdominal pain as children had depression during their lifetime, compared with 16 percent of adults in the control group.
Approximately 50 percent of those who had FAPS as kids had social anxiety, phobias or other anxiety disorders while growing up or in adulthood, compared with about 20 percent of people without FAPS.
The findings suggest that anxiety should be taken into account when treating children who get frequent stomach aches, the researchers said.
“It’s not just that they are anxious because of the pain. We saw that once the abdominal pain went away, they still had clinically significant anxiety,” said study researcher Dr. Lynn Walker, professor of pediatrics at Vanderbilt University in Nashville.
“We need to address the pain and anxiety together, and help kids cope better with their discomfort,” Walker said.
Stomach aches are common in children, but some children who are otherwise healthy get “medically unexplained” stomach aches, sometimes several times a day. As children grow up, the pain usually diminishes, but it can still interfere with their normal lives, making it difficult to attend school or play with other kids.
“The children might be more likely to stay home, get behind school work and be no longer connected with their friends, which over time may create a lot of stress for them,” Walker said.
The unexplained stomach aches can be a source of stress for parents too, who may become too protective, triggering even more worry in the child that something may be wrong.
“Once the physician has done the proper evaluation, and says there’s really nothing seriously wrong here, then the parents should start behaving more like a coach, and encourage the children to continue their activities, instead of keeping them at home.”
The cause of FAPS is still unknown, but it is thought that the nervous system might play a role.
“It’s not that the pain is not real,” Walker said, but it might be that the brain doesn’t properly respond to the sensations coming from the gut.
“We have a natural ability to turn down the pain signal once whatever is wrong has healed, or if there’s nothing wrong. People who are anxious have more difficulty turning off the alarm system,” she said.
Study participants experienced both anxiety and abdominal pain early in childhood, and the researchers could not identify which came first. Perhaps some children are genetically predisposed to have both anxiety and a hypersensitivity to pain, they said.
Another possibility is that a stomachache could trigger stress in some children, which in turn makes them more observant and attentive to minor discomforts, therefore feeding into a vicious cycle, Walker said.
“We think that chronic pain is better treated in a multidisciplinary fashion, in which you not only have to look for a disease, but you also look at emotional and psychological aspects of it, and address all of those together in an integrated fashion,” she said.