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The phantom pains of childhood.

The Doctor's Dilemma (and the Patients', too) - A Child's Agony with No Apparent Cause

A child describes severe pain, complaining that it has gone on for months, even years. Yet a complete examination reveals no medical explanation.

Can this pain be psychosomatic? If so, can anything be done?

A group of Seattle pediatric rheumatologists answer both questions "yes" and cite a recent study of 100 young patients as evidence.

Psychosomatic pain is not unusual in children, and it is important to make that diagnosis, when appropriate, to avoid unnecessary medical intervention. Diagnosis of psychogenic musculoskeletal pain is a first step in easing symptoms -- usually achieved through a course of physical or occupational therapy and psychiatric referral.

"The typical child with psychosomatic pain is a preadolescent girl who is under a great deal of stress from family or school and tends to be highly driven, achievement oriented, and compliant," said Dr. David D. Sherry, director of clinical pediatric rheumatology at Children's Hospital and Medical Center in Seattle, Washington. "These patients are not malingerers -- they experience real pain, but it seems to be functional rather than organic."

A child who appears to suffer from psychogenic pain should undergo a complete physical examination, including a thorough musculoskeletal and neutologic check, in order to rule out organic disease.

A Seattle study in which Dr. Sherry had been involved tells a great deal about those with the disorder. It describes the roles of stress and family environment, emphasizing that affected youngsters usually respond readily to treatment.

A team of five physicians conducted a three-year study of 100 children, ages 3 to 20, admitted to the Seattle Medical Center. Previous treatments had uncovered no organic explanation for any of the symptoms, and all had experienced pain for an average of a year. The extent of disability varied from those whose fear of pain limited their daily activities to those who complained of constant pain and were highly dysfunctional, but all missed a great deal of school and had stopped doing many activities in which they were once engaged.

Among the study's most significant findings:

* 68 percent had a "role model" with chronic pain, usually another family member.

* 96 percent appeared to be in less pain than they reported. For example, a child would say "It's really killing me" but would be smiling.

* 89 percent came from families with abnormal psychodynamics. Many children were involved in stressful family situations or had recently experienced major life events.

Many of the afflicted families tended to deal with underlying tensions by focusing on the child's medical problem, Dr. Sherry said. In this way, the child also can get the parental attention that may previously have been lacking.

It can be important to bring up the issue of stress and the role it plays in psychogenic pain, but it's also important to reassure such children that one knows that the pain they experience is "real."

Treatment for subjects in the Seattle study was highly effective. The children received intensive physical and occupational therapy and were referred to a mental health professional for individual or family psychotherapy.

After treatment, 78 percent reported no more pain, although 15 later experienced relapses. Nineteen children continued to have some pain but became fully functional, and three continued to have severe pain.

Dr. Sherry emphasizes the importance of therapy in preventing a recurrence of pain in those who get treatment.

"My fear is that if they don't learn how to deal with stress in a more constructive way, they're going to take it out on their bodies again," he said.
COPYRIGHT 1992 Vegetus Publications
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Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Publication:Nutrition Health Review
Date:Jun 22, 1992
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