eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Somatoform Disorder: Pain: Follow-up

Author: Dolores Protagoras-Lianos, MD, Director of Outpatient Department, Department of Pediatrics, Aghia Sophia Children's Hospital, Athens, Greece
Contributor Information and Disclosures

Updated: Sep 10, 2008

Follow-up

Further Inpatient Care

  • Medical care for physical illness must be appropriate for diagnosed medical problems, and inpatient care should be limited to concerns about acute or chronic serious medical illness.

Further Outpatient Care

  • Medical care for physical illness must be appropriate for diagnosed medical problems and requires judicious use of analgesics.
  • Close communication should be maintained between the primary care physician and the mental health professional. A team approach helps assure that all aspects of the child's health are being addressed.

Prognosis

  • Outcome measure (physical symptoms): In the spectrum of physical symptoms, recurrent abdominal pain has been studied.
    • Seventy percent of patients continue to experience abdominal pain into adulthood; the symptom does not impair activity as in childhood but is more significant than in control subjects.5
    • Additional symptoms, such as headaches, develop in 30% of patients.
    • Multiple symptoms in childhood predict poorer adult outcome.
  • Outcome measure (functional and psychiatric status): In adulthood, individuals with a childhood history of recurrent abdominal pain are more likely than control subjects to have an anxiety disorder, hypochondriacal beliefs, or poor social functioning, and they are more likely to be treated with psychoactive medication.
  • With psychological intervention, improved short-term and long-term outcomes have been reported.

Patient Education

  • Encourage the patient's acceptance of an alternative diagnosis of the pain other than severe illness.
  • Help the patient understand the role of psychological factors.
  • Help the patient discover strategies for coping with the symptoms.
  • Seek ways to reduce stressors that maintain the symptoms.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize the presence of serious physical disease in the patient (Systematic medical follow-up care minimizes this possibility.)
  • Excessive unfounded testing for organic disease
    • Headache: With detailed history, physical examination, and neurologic examination, the correct diagnosis can be made on the first visit in 80-90% of patients. In retrospective studies of children with brain tumors, suspect symptoms and signs appeared within several months of the onset of headaches.
    • Abdominal pain: With detailed history, physical examination, and laboratory investigation based on clinical suspicion, follow-up care rarely reveals an occult physical problem.
  • Regarding pain disorder as a diagnosis of exclusion without positive evidence for the role of psychological factors
  • Failure to recognize underlying mental health problems
  • Insufficient exploration of the social environment
 


More on Somatoform Disorder: Pain

Overview: Somatoform Disorder: Pain
Differential Diagnoses & Workup: Somatoform Disorder: Pain
Treatment & Medication: Somatoform Disorder: Pain
Follow-up: Somatoform Disorder: Pain
References
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References

  1. APA. Diagnostic and Statistic Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.

  2. Goubert L, Eccleston C, Vervoort T, Jordan A, Crombez G. Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): a preliminary validation. Pain. Aug 2006;123(3):254-63. [Medline].

  3. Tanaka H, Mollborg P, Terashima S, Borres MP. Comparison between Japanese and Swedish schoolchildren in regards to physical symptoms and psychiatric complaints. Acta Paediatr. Nov 2005;94:1661-66. [Medline].

  4. Soderholm JD, Perdue MH. Stress and gastrointestinal tract. II. Stress and intestinal barrier function. Am J Physiol Gastrointest Liver Physiol. Jan 2001;280:G7-G13. [Medline].

  5. Campo JV, Di Lorenzo C, Chiappetta L, et al. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it?. Pediatrics. Jul 2001;108(1):E1. [Medline]. [Full Text].

  6. Alfven G, Lindstrom A. A new method for the treatment of recurrent abdominal pain of prolonged negative stress origin. Acta Paediatr. Jan 2007;96:76-81. [Medline].

  7. Campo JV, Bridge J, Ehmann M, et al. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics. Apr 2004;113(4):817-24. [Medline]. [Full Text].

  8. Drotar D, Wolraich ML, Felice ME. The Classification of Child and Adolescent Mental Diagnoses in Primary Care, Diagnostic and Statistical Manual for Primary Care (DSM-PC). Elk Grove, Ill: American Academy of Pediatrics; 1996.

  9. Ehlert U, Straub R. Physiological and emotional response to psychological stressors in psychiatric and psychosomatic disorders. Ann N Y Acad Sci. Jun 30 1998;851:477-86. [Medline].

  10. Ghandour RM, Overpeck MD, Huang ZJ, et al. Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors. Arch Pediatr Adolesc Med. Aug 2004;158(8):797-803. [Medline].

  11. Hermann C, Zohsel K, Hohmeister J, Flor H. Cortical correlates of an attentional bias to painful and innocuous somatic stimuli in children with recurrent abdominal pain. Pain. Jun 2008;136(3):397-406. [Medline].

  12. Hjern A, Alfven G, Ostberg V. School stressors, psychological complaints and psychosomatic pain. Acta Paediatr. Jan 2008;97:112-117. [Medline].

  13. Kozlowska K, Rose D, Khan R, Kram S, Lane L, Collins J. A conceptual model and practice framework for managing chronic pain in children and adolescents. Harv Rev Psychiatry. Mar-Apr 2008;16:136-50. [Medline].

  14. Liakopoulou-Kairis M, Alifieraki T, Protagora D, et al. Recurrent abdominal pain and headache--psychopathology, life events and family functioning. Eur Child Adolesc Psychiatry. Jun 2002;11(3):115-22. [Medline].

  15. Petersen S, Brulin C, Bergström E. Recurrent pain symptoms in young schoolchildren are often multiple. Pain. Mar 2006;121(1-2):145-50. [Medline].

  16. Ramchandani PG, Hotopf M, Sandhu B, et al. The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study. Pediatrics. Jul 2005;116(1):46-50. [Medline]. [Full Text].

  17. Ramchandani PG, Stein A, Hotopf M, et al. Early parental and child predictors of recurrent abdominal pain at school age: results of a large population-based study. J Am Acad Child Adolesc Psychiatry. Jun 2006;45(6):729-36. [Medline].

  18. Sanders D. Counseling for Psychosomatic Problems. London, England: Sage Publications; 1995.

  19. Santalahti P, Aromaa M, Sourander A, et al. Have there been changes in children's psychosomatic symptoms? A 10-year comparison from Finland. Pediatrics. Apr 2005;115(4):e434-42. [Medline]. [Full Text].

  20. Stein MT, Crow J, Abbott M, Tanner JL. Organic or psychosomatic? Facilitating inquiry with children and parents. J Dev Behav Pediatr. Oct 2004;25(5 Suppl):S97-101. [Medline].

  21. Vervoort T, Goubert L, Eccleston C, et al. Catastrophic Thinking About Pain is Independently Associated with Pain Severity, Disability, and Somatic Complaints in School Children and Children with Chronic Pain. J Pediatr Psychol. Aug 2006;31(7):674-83. [Medline].

  22. Walker LS, Smith CA, Garber J, Claar RL. Appraisal and coping with daily stressors by pediatric patients with chronic abdominal pain. J Pediatr Psychol. Mar 2007;32:206-216. [Medline].

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Further Reading

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Keywords

somatoform disorder, pain disorder, recurrent abdominal pain, headache, limb pain, chest pain, anxiety, depression, psychosomatic pain, suicide, gut dysmotility

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Contributor Information and Disclosures

Author

Dolores Protagoras-Lianos, MD, Director of Outpatient Department, Department of Pediatrics, Aghia Sophia Children's Hospital, Athens, Greece
Dolores Protagoras-Lianos, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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