J Pediatr. 2021 Apr 30;S0022-3476(21)00411-X. doi: 10.1016/j.jpeds.2021.04.059.Online ahead of print.

Bruno P Chumpitazi ¹, Tonya M Palermo ², John M Hollier ³, Mariella M Self ³, Danita Czyzewski ³, Erica M Weidler ⁴, Margaret Heitkemper ⁵, Robert J Shulman ⁴

Author information

• ¹Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Children's Nutrition Research Center, United States Department of Agriculture, Houston, TX USA. Electronic address: chumpita@bcm.edu.
• ²Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle WA.
• ³Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
• ⁴Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Children's Nutrition Research Center, United States Department of Agriculture, Houston, TX USA.
• ⁵Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA USA.

Abstract

Objectives: To characterize the types of multisite pain experienced by children with functional abdominal pain disorders (FAPDs) and to examine differences in psychosocial distress, functional disability and health-related quality of life in children with multisite pain vs. abdominal pain alone.

Study design: Cross-sectional study of children ages 7-17 years (n=406) with pediatric Rome III FAPDs recruited from both primary and tertiary care between January 2009 and June 2018. Subjects completed 14-day pain and stool diaries, as well as validated questionnaires assessing abdominal and non-abdominal pain symptoms, anxiety, depression, functional disability and health-related quality of life.

Results: 295 (73%) children endorsed at least one co-occurring non-abdominal pain thus were categorized as having multisite pain with the following symptoms: 172 (42%) headaches, 143 (35%) chest pain, 134 (33%) muscle soreness, 110 (27%) back pain, 94 (23%) joint pain, and 87 (21%) extremity (arms and legs) pain. In addition, 200 children (49%) endorsed two or more non-abdominal pain symptoms. Participants with (vs without) multisite pain had significantly higher abdominal pain frequency (P<0.001) and severity (P = .03), anxiety (P<0.001), and depression (P<0.001). Similarly, children with multisite pain (vs. without) had significantly worse functional disability (P<0.001) and health-related quality of life scores (P<0.001). Increasing number of multisite pain sites (P<0.001) was associated with increased functional disability when controlling for demographic and other clinical factors.

Conclusions: In children with FAPDs, non-abdominal multisite pain is highly prevalent and is associated with increased psychosocial distress, abdominal pain frequency and severity, functional disability, and lower health-related quality of life.