As students settle back into their desks for another school year, parents, school nurses and pediatricians respond to increased complaints of stomach pain. Many of these seasonal belly-aches are dismissed as nothing more than a case of the back-to-school blues. However, in many instances the pain kids feel is the result of a complicated and often misdiagnosed medical condition that researchers at Nationwide Children’s Hospital now believe could be helped with the use of medications typically used to treat depression.
“Functional abdominal pain is one of the most common reasons children are referred to our gastrointestinal clinic,” said Carlo Di Lorenzo, MD, chief of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s Hospital and a faculty member at The Ohio State University College of Medicine. “Each year, when students return to class, we see an increase in the number of patients complaining of abdominal pain.”
Functional abdominal pain is stomach pain that is not associated with any evidence of a physical disease or tissue damage. The condition is estimated to affect as many as 10 percent of children, many of whom also have a history of depression, anxiety, migraine headaches and/or fatigue. The pain also tends to occur more frequently during times of stress and anxiety, including during school, sports and other activities. Although the cause of the pain isn’t clear, the pain itself is very real.
“It really does hurt, and these kids really do suffer. Their parents suffer too, because they are often terribly worried that something very serious may be wrong and they see how the symptoms can interfere with the child’s life,” said John Campo, MD, chief of Child and Adolescent Psychiatry and a pediatrician at Nationwide Children’s Hospital. “We know that as a group, these kids miss more school than unaffected kids. They don’t do as well in school, either.”
Dr. Campo, Dr. Di Lorenzo and investigators at The Research Institute at Nationwide Children’s Hospital are now looking into ways to give kids some relief from the chronic pain. Currently, patients are taught coping techniques, such as relaxation training and guided imagery, to help manage the pain. Now researchers believe the use of medications, traditionally used as antidepressants, may help lessen the pain, or prevent it altogether.
Clinical trials are underway at Nationwide Children’s Hospital to test the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in the treatment of functional abdominal pain. SSRIs affect the handling of serotonin in the body.
“People have thought about serotonin as being important in anxiety and depression,” said Dr. Campo, also a member of the faculty at The Ohio State University College of Medicine. “While that’s true, what’s really interesting is that 95 percent of our body’s serotonin is in our intestinal track.”
Serotonin transmits messages of pain to the brain and the local nervous system in the stomach. Researchers hope that changing the way the body handles serotonin may help ease functional abdominal pain. So far, a type of SSRI, known as citalopram, has shown promise. In a preliminary study of the medication, citalopram appeared to ease abdominal pain in approximately 80 percent of cases, but Dr. Campo stresses that more research is needed.
Doctors recommend that children with recurrent or persistent abdominal pain be checked out by a doctor. Medical treatment should be sought immediately if a child experiences blood in vomit or bowel movements, fevers, weight loss or persistent vomiting.
Although functional abdominal pain tends to be more common in girls (especially after puberty), it affects both boys and girls. It often develops during two peak times in a child’s development: between 4 and 6 years of age or later in life, during late childhood or early adolescence.
*Nationwide Children’s Hospital is still accepting patients for studies involving functional abdominal pain. For more information, contact Maureen Maher-Bridge by phone at 614-722-6432 or by email at Maureen.Maher-Bridge@NationwideChildrens.org.