Goals of Treatment

The goal of treating patients with functional abdominal pain is restoration of normal function. Treatment may not provide total freedom from pain symptoms, and must be

TABLE 40-7. Tests to be Done On All Patients with Chronic Recurrent Abdominal Pain

2. Urinalysis

3. Sedimentation rate

4. Occult blood in stool

5. Stool for ova and parasites

CBC = complete blood count.

TABLE 40-8. Selective Tests to be Done if Indicated and/or Parents Will Not Accept Functional Diagnosis

1. Ultrasonography of upper and lower abdomen

2. Upper gastrointestinal and small bowel series

3. Barium enema

4. Liver function tests

5. Pancreatic function tests

6. C13 urea breath test for Helicobacter pylori

7. Fecal a-1-antitrypsin determination

8. Upper and lower gastrointestinal endoscopy individualized. The families must be given a positive diagnosis and told the child has functional abdominal pain, with an explanation of the nature of the symptoms and their presumptive pathophysiology. Most important is to tell the family and the child that the symptoms are real and not imagined, and that they are caused by disordered intestinal function in response to a wide variety of stressful stimuli. It is appropriate to say to the child and the parents that in some individuals, certain stresses result in abnormal function that in others do not have the same effect but could result in other symptoms such as headache or skin rashes.

The test results should be presented and explained to the family and child to tell them which conditions have been excluded. Typically, I review with the family the radiographic studies and all prior tests to show that they were normal. If the family is worried about a particular condition or illness, it must be tested for or the family made aware that the symptoms do not fit the condition. Discuss with the family why the child does not have a variety of common GI disorders, including peptic ulcer disease, IBD, and cancer.

The goals of treatment are to identify and clarify adverse stresses that may provoke the pain and to reverse environmental reinforcementof the pain behavior. The parents and the school officials must be made aware that the child should be supported rather than the pain. The lifestyle of the child should be normal, and the child should attend school every day, regardless of the presence of pain. The physician can communicate directly with school officials to explain the nature of the problem and not to let it disrupt attendance, class activity, or performance expectations. The patients should not be sent home unless there is objective evidence of disease, such as fever or vomiting. If necessary, the child may be allowed to rest in the nurse's or school office until ready to return to class. The parent must learn not to come to school if called by their child and to work with the school to develop a plan for pain management. Giving reassurance to the patient is important. In the home, the child must learn to become independent and to develop coping skills to deal with the pain. Less attention should be directed toward the symptoms.

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