Pain Somatoform Disorder Workup
- Author: Dolores Protagoras-Lianos, MD; Chief Editor: Caroly Pataki, MD more...
The primary physician orders laboratory studies based on clinical suggestion of a specific medical condition.
The primary physician orders imaging studies based on clinical suggestion of a specific medical condition.
Otti et al studied patients with somatoform pain disorder using resting functional MRI. Although the study demonstrated the resting functional network connectivity among pain-related interactions, it was unable to conclusively characterize the reasons for the pain
The diagnosis of pain disorder rests not only on the physician’s inability to fully explain the pain on an organic basis, but also on the presence of psychological factors. The following are prerequisite conditions for successful referral by a medical practitioner to a mental health professional:
Timely, thorough medical evaluation
Interview and observation of family for psychosocial problems
Early mention of possibility that symptoms are stress-related
Discussion of negative medical workup results
Rationale provided for mental health referral
Assurance of ongoing medical follow-up care and collaboration with mental health specialist
Mental health evaluation may involve the following:
Quantifying the pain: Faces Pain Scale–Revised (FPS-R) and Color Analog Scale (CAS) are self-report pain scales
Observation scales are used with preschool-aged children
Direct scaling techniques that ask that young children pick out from a graded series the drawings of faces that match the way they feel
Pain questionnaires for older children and adolescents
Screening instruments, such as the Child Behavior Checklist, to identify children with somatic symptoms and possible somatoform disorders
Trauma Symptom Checklist for Children
ISPCAN Child Abuse Screening Tool Children's Version (ICAST-C)
Child Trauma Questionnaire-Short Form A self report questionnaire which may be used with adolescents 
Comprehensive structured interviews, such as the Diagnostic Interview for Children and Adolescents (DICA), that contain questions on somatization 
The Personality Inventory for Children (PIC), which has been used in the diagnosis of somatoform disorders in children
Projective tests that may help clarify underlying psychological issues and add to the evidence for a somatoform diagnosis include the Thematic Apperception test (TAT), the Children's Apperception Test (CAT), the Rorschach test, and sentence completion. Psychoeducational evaluation is recommended for patients with academic difficulties and prolonged school absence.
APA. Diagnostic and Statistic Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.
American Academy of Pediatrics. Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Versions. Elk Grove Village, IL: 1996.
Soderholm JD, Perdue MH. Stress and gastrointestinal tract. II. Stress and intestinal barrier function. Am J Physiol Gastrointest Liver Physiol. 2001 Jan. 280(1):G7-G13. [Medline].
McEwen BS. Understanding the potency of stressful early life experiences on brain and body function. Metabolism. 2008 Oct. 57 Suppl 2:S11-5. [Medline].
Ehlert U, Straub R. Physiological and emotional response to psychological stressors in psychiatric and psychosomatic disorders. Ann N Y Acad Sci. 1998 Jun 30. 851:477-86. [Medline].
Bener A, Al-Kazaz M, Ftouni D, Al-Harthy M, Dafeeah EE. Diagnostic overlap of depressive, anxiety, stress and somatoform disorders in primary care. Asia Pac Psychiatry. 2013 Mar. 5(1):E29-38. [Medline].
Busch V, Haas J, Cronlein T, et al. Sleep deprivation in chronic somatoform pain-effects on mood and pain regulation. Psychiatry Res. 2012 Feb 28. 195(3):134-43. [Medline].
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. 2006 Aug. 123(3):254-63. [Medline].
Vervoort T, Goubert L, Eccleston C, Bijttebier P, Crombez G. 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. 2006 Aug. 31(7):674-83. [Medline].
Logan DE, Williams SE, Carullo VP, Claar RL, Bruehl S, Berde CB. Children and adolescents with complex regional pain syndrome: more psychologically distressed than other children in pain?. Pain Res Manag. 2013 Mar-Apr. 18(2):87-93. [Medline]. [Full Text].
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. 2008 Jun. 136(3):397-406. [Medline].
Ghandour RM, Overpeck MD, Huang ZJ, Kogan MD, Scheidt PC. Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors. Arch Pediatr Adolesc Med. 2004 Aug. 158(8):797-803. [Medline].
Campo JV, Bridge J, Ehmann M, et al. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics. 2004 Apr. 113(4):817-24. [Medline].
Santalahti P, Aromaa M, Sourander A, Helenius H, Piha J. Have there been changes in children's psychosomatic symptoms? A 10-year comparison from Finland. Pediatrics. 2005 Apr. 115(4):e434-42. [Medline].
Ramchandani PG, Hotopf M, Sandhu B, Stein A. The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study. Pediatrics. 2005 Jul. 116(1):46-50. [Medline].
Silber TJ. Somatization disorders: diagnosis, treatment, and prognosis. Pediatr Rev. 2011 Feb. 32(2):56-63; quiz 63-4. [Medline].
Vanaelst B, De Vriendt T, Ahrens W, Bammann K, Hadjigeorgiou C, Konstabel K. Prevalence of psychosomatic and emotional symptoms in European school-aged children and its relationship with childhood adversities: results from the IDEFICS study. Eur Child Adolesc Psychiatry. 2012 May. 21(5):253-65. [Medline].
Tanaka H, Mollborg P, Terashima S, Borres MP. Comparison between Japanese and Swedish schoolchildren in regards to physical symptoms and psychiatric complaints. Acta Paediatr. 2005 Nov. 94(11):1661-6. [Medline].
Petersen S, Brulin C, Bergstrom E. Recurrent pain symptoms in young schoolchildren are often multiple. Pain. 2006 Mar. 121(1-2):145-50. [Medline].
Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997 Oct. 36(10):1329-38. [Medline].
Alfven G. The covariation of common psychosomatic symptoms among children from socio-economically differing residential areas. An epidemiological study. Acta Paediatr. 1993. 82:484 – 487.
Hjern A, Alfven G, Ostberg V. School stressors, psychological complaints and psychosomatic pain. Acta Paediatr. 2008 Jan. 97(1):112-7. [Medline].
Liakopoulou-Kairis M, Alifieraki T, Protagora D, et al. Recurrent abdominal pain and headache--psychopathology, life events and family functioning. Eur Child Adolesc Psychiatry. 2002 Jun. 11(3):115-22. [Medline].
Gini G, Pozzoli T. Association between bullying and psychosomatic problems: a meta-analysis. Pediatrics. 2009 Mar. 123(3):1059-65. [Medline].
Sourander A, Brunstein Klomek A, Ikonen M, Lindroos J, Luntamo T, Koskelainen M. Psychosocial risk factors associated with cyberbullying among adolescents: a population-based study. Arch Gen Psychiatry. 2010 Jul. 67(7):720-8. [Medline].
Ramchandani PG, Stein A, Hotopf M, Wiles NJ. 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. 2006 Jun. 45(6):729-36. [Medline].
Stein MT, Crow J, Abbott M, Tanner JL. Organic or psychosomatic? Facilitating inquiry with children and parents. J Dev Behav Pediatr. 2004 Oct. 25(5 Suppl):S97-101. [Medline].
Otti A, Guendel H, Henningsen P, Zimmer C, Wohlschlaeger AM, Noll-Hussong M. Functional network connectivity of pain-related resting state networks in somatoform pain disorder: an exploratory fMRI study. J Psychiatry Neurosci. 2013 Jan. 38(1):57-65. [Medline]. [Full Text].
Thabrewa H, de Sylvac S, Romansa E. Evaluating Childhood AdversityAdv Psychosom Med. Basel, Karger. J Pediatr Psychol. 2012. 32:35–57.
Sharma MP, Manjula M. Behavioural and psychological management of somatic symptom disorders: an overview. Int Rev Psychiatry. 2013 Feb. 25(1):116-24. [Medline].
Gottsegen D. Hypnosis for functional abdominal pain. Am J Clin Hypn. 2011 Jul. 54(1):56-69. [Medline].
Somashekar B, Jainer A, Wuntakal B. Psychopharmacotherapy of somatic symptoms disorders. Int Rev Psychiatry. 2013 Feb. 25(1):107-15. [Medline].
Sanders D. Counseling for Psychosomatic Problems. London, England: Sage Publications; 1995.
Alfven G, Lindstrom A. A new method for the treatment of recurrent abdominal pain of prolonged negative stress origin. Acta Paediatr. 2007 Jan. 96(1):76-81. [Medline].
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. 2008. 16(2):136-50. [Medline].
Campo JV, Di Lorenzo C, Chiappetta L, et al. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it?. Pediatrics. 2001 Jul. 108(1):E1. [Medline].
Cohen P, Pine DS, Must A, Kasen S, Brook J. Prospective associations between somatic illness and mental illness from childhood to adulthood. Am J Epidemiol. 1998 Feb 1. 147(3):232-9. [Medline].
Roth-Isigkeit A, Thyen U, Stoven H, Schwarzenberger J, Schmucker P. Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics. 2005 Feb. 115(2):e152-62. [Medline].
Walker LS, Smith CA, Garber J, Claar RL. Appraisal and coping with daily stressors by pediatric patients with chronic abdominal pain. J Pediatr Psychol. 2007 Mar. 32(2):206-16. [Medline]. [Full Text].