Researchers at Semmelweis University analyzed data from 522 Hungarian schoolchildren aged 11 to 18 in a nationally representative study. Their findings show that in adolescents with functional abdominal pain disorders (FAPDs) — conditions characterized by recurrent or persistent abdominal pain that is not explained by an organic disease — abdominal pain often occurs alongside pain in other parts of the body. Overall, 80.6% experienced multisite pain, meaning pain at two or more body sites, while 54.8% reported their primary pain site outside the abdomen. Headache was the most common, while joint and back pain were also reported. In more than half of those affected, symptoms had persisted for at least a year.
According to the researchers, the process may initially be triggered, for example, by an infection or inflammation. However, if the pain persists and is accompanied by stress, anxiety, or other psychological strain, the pain-processing system may gradually become hypersensitive and remain in this state even after the original trigger has resolved. Even relatively mild stimuli may then be enough to trigger pain, and over time even normal bodily processes — such as digestion beginning after a meal — may become painful despite normally causing no discomfort. This may help explain why the pain can persist and occur in several parts of the body.
“If a school-age child has abdominal pain, it can be worth looking a little deeper and asking whether they also experience pain elsewhere. If they do, this may suggest that the pain may not simply be a symptom of an organic condition, but part of a more complex pain disorder. This can be the case even if the child was previously diagnosed with an organic condition such as celiac disease or Crohn’s disease, because that condition may no longer be what is causing the symptoms,” says Dr. János Major, first author of the study, senior lecturer at the Institute of Behavioural Sciences at Semmelweis University and head of the Paediatric Pain Centre at Bethesda Children’s Hospital.
Adolescents with FAPDs were more likely to feel that they faced too many assessments at school, that there was not enough peace and quiet in the classroom, or that teachers treated them unfairly. Peer exclusion and other forms of harassment were also more common among them.
The researchers also examined the health-related quality of life (HRQOL) of the children affected. They assessed not only physical functioning but also emotional functioning, social functioning, and everyday school functioning. Questions on emotional functioning covered issues including fear, sadness, anger, sleep problems, and worries. Social functioning looked at how children got along with their peers, including whether they were excluded or teased and how well they were able to fit in. School functioning included factors such as their ability to concentrate and keep up with schoolwork, as well as how many school days they missed because of feeling unwell or attending medical appointments.
According to the study, adolescents with FAPDs scored significantly worse across all areas assessed, and 14.5% had overall HRQOL scores in the extremely low range. Verbal harassment — such as teasing, mocking, or name-calling — was also associated with extremely low HRQOL. Those affected also missed more days of school, and regular analgesic use was more common among them.
The researchers say these symptoms should therefore be taken seriously. Without treatment, the underlying factors do not necessarily resolve on their own, and the pain may persist into adulthood, significantly affecting quality of life and everyday functioning. In the longer term, persistent severe pain may place a substantial burden on health care systems, lead to difficulties maintaining employment, and, in severe cases, even result in early disability.
“Parents often tend to play the problem down and say that it will pass or that the child will grow out of it. The problem is that the factors triggering or maintaining the pain do not necessarily disappear on their own,” says Dr. Szilvia Ádám, last author of the study and associate professor at the Health Services Management Training Center at Semmelweis University.
With appropriate support, the condition can be treated successfully. In some cases, even changing schools or a short course of psychotherapy can make a considerable difference, while pain treatment initiated in childhood may reduce the likelihood that the pain will persist or recur in adulthood.
Robert Cseszregi
Photo: Boglárka Zellei – Semmelweis University
Cover photo and illustration: iStock by Getty Images/Yuliia Kaveshnikova
