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Vol. 53. Núm. 5.
Páginas 458-468 (Noviembre 2000)
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Vol. 53. Núm. 5.
Páginas 458-468 (Noviembre 2000)
Acceso a texto completo
Dolores abdominales recurrentes en atención primaria: estudio del dolor abdominal recurrente funcional
Recurrent abdominal pain in general practice: study of functional recurrent abdominal pain
Visitas
8721
C.L. Sanz de la Garzaa,b,*, S. Gámez Guerreroa, E. Serrano Guerrab, J.R. Gutiérrez Casaresa
a Unidad de Hospitalización Breve de Psiquiatría. Hospital Infanta Cristina. Badajoz
b Centro de Salud Mental Infanto-Juvenil. Hospital Central de Asturias. Oviedo
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En la práctica clínica diaria gran número de padres acuden con sus hijos a las consultas de pediatría por dolores abdominales que cursan de forma recurrente. La experiencia clínica acumulada ha demostrado que una vez realizadas las pruebas diagnósticas pertinentes, la mayoría de estos cuadros no presentan causa orgánica que los justifique y por ello son denominados dolores abdominales recurrentes funcionales. La aparatosidad de estos cuadros clínicos suele llevar a los padres a solicitar consultas médicas urgentes, realizar numerosas pruebas complementarias y, en los casos graves, a ingresos hospitalarios durante tiempo prolongado que no suelen demostrar eficacia terapéutica y suponen un riesgo añadido para la salud mental de estos niños. En la mayoría de los casos están implicados elementos psíquicos que son determinantes en el inicio y mantenimiento de los dolores, por lo que es imprescindible un abordaje mixto psicopediátrico que preserve en todo momento la continuidad terapéutica. Por todo ello se ha considerado conveniente revisar los aspectos psiquiátricos y psicológicos implicados en esta enfermedad.

Palabras clave:
Dolor abdominal
Niño
Trastornos del comportamiento infantiles
Rol de enfermo
Trastornos somatoformes

Pediatricians find that in daily clinical practice they are frequently visited by parents with children that have recurrent abdominal pain. Clinical experience has demonstrated that, after performing all relevant diagnostic tests, no medical condition justifying such investigations is involved in more than half of these disorders. Consequently, these disorders are called functional recurrent abdominal pain. The dramatic nature of their children' s symptoms often leads parents to seek urgent medical consultations and ask for additional complementary tests; in serious cases, these disorders can lead to prolonged hospitalization with no proven therapeutic efficacy and which pose an additional risk for the child' s mental health. In most patients, psychological factors are involved which play a key role in the onset and persistent nature of abdominal pains. Consequently, a psychopediatric approach preserving therapeutic continuity should be adopted. For these reasons, we consider a review of the psychiatric and psychological aspects involved in this disorder to be opportune.

Key words:
Abdominal pain
Child
Child behavior disorders
Sick role somatoform disorders
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Bibliogrífia
[1.]
J. Apley, N. Nalsh.
Recurrent abdominal pains: A field survey of 1.000 school children.
Arch Dis Child, 33 (1958), pp. 165-170
[2.]
J. Garber, D.A. Van Slyke, L.S. Walker.
Concordance between mothers' and children' s report of somatic and emotional symptoms in patients with recurrent abdominal pain or emotional disorders.
J Abnorm Child Psychol, 26 (1998), pp. 381-391
[3.]
T. Lissauer, G. Clayden.
Gastroenterología.
Texto ilustrado de Pediatría, 1.a ed, pp. 123-137
[4.]
L. Schraff.
Recurrent abdominal pain in children: a review of psychological factors and treatment.
Clin Psychol Rev, 17 (1997), pp. 145-166
[5.]
J. Oster.
Recurrent abdominal pain, headache and limb pains in children and adolescents.
Pediatrics, 50 (1972), pp. 429-435
[6.]
M. Green.
Diagnosis and treatment: psychogenic, recurrent, abdominal pain.
Pediatrics, 40 (1967), pp. 84-89
[7.]
J.S. Hyams, G. Burke, P.M. Davis, et al.
Abdominal pain and irritable bowel syndrome in adolescents: a community based study.
J Pediatr, 129 (1996), pp. 220-225
[8.]
A.l. Wasserman, P.f. Whitington, F.P. Rivera.
Psychogenic basis for abdominal pain in children and adolescents.
J Am Acad Child Adolesc Psychiatry, 27 (1988), pp. 179-184
[9.]
M.F. Christensen, O. Mortensen.
Long-term prognosis in children with recurrent abdominal pain.
Arch Dis Child, 50 (1975), pp. 110-114
[10.]
R. Friedman.
Some characteristics of children with “ psychogenic” pain.
Clin Pediatr, 11 (1972), pp. 331
[11.]
J. Apley, B. Hale.
Children with recurrent abdominal pain: how do they grow up?.
BMJ, 3 (1973), pp. 7-9
[12.]
M.E. Avery, L.R. First.
Pediatric Medicine, 1.a ed.
[13.]
A.I. Busbaum, H.L. Fields.
Endogenous pain control systems: Brainstem spinal pathways and endorphin circuitry.
Ann Rev Neurosci, 7 (1984), pp. 309-338
[14.]
D.K. Routh, A.R. Ernst.
Somatisation disorder in relatives of children and adolescents with functional abdominal pain.
J Pediatr Psychol, 9 (1984), pp. 427-437
[15.]
L.S. Walker, J.W. Green.
Children with recurrent abdominal pain and their parents: more somatic complaints, anxiety, and depression than other patient families?.
J Pediatr Psychol, 14 (1989), pp. 231-243
[16.]
J. Apley.
The child with abdominal pains, 2.a ed.
[17.]
R. Bennet Osborne, J.W. Hatcher, A.J. Richtsmeier.
The role of social modelling in unexplained pediatric pain.
J Pediatr Psychol, 14 (1989), pp. 43-61
[18.]
L.S. Walker, J. Garber, J.W. Greene.
Psychosocial correlates of recurrent childhood pain: a comparison of pediatric patients with recurrent abdominal pain, organic illness and psychiatric disorders.
J Abnorm Psychol, 1023 (1993), pp. 248-258
[19.]
T.K.F. Craig, H. Drake, K. Mills, A.P. Boardman.
The South London somatisation study II: influence of stressful life events and secondary gain.
Br J Psychiatry, 165 (1994), pp. 248-258
[20.]
A.J. Ferreira.
Family myth and homeostasis.
Arch Gen Psychiatry, 9 (1963), pp. 457-463
[21.]
N.C. Avery.
Family secrets.
Psychoanal Rev, 69 (1982), pp. 471-486
[22.]
J.M. Robbins, L.J. Kirmayer.
Attributions of common somatic symptoms.
Psychol Med, 21 (1991), pp. 1029-1045
[23.]
M. Hirsch.
Two forms of identification with the aggressor according to Ferenczi and Anna Freud.
Prax Kinderpsychol Kinderpsychiatr, 45 (1996), pp. 198-205
[24.]
G.J. Taylor, M. Baglay, D.P. Ryan.
Parker JDA. Validation of the Alexythimia Construct: a measurement-based approach.
Can J Psychiatry, 35 (1990), pp. 290-297
[25.]
M.E. Garralda.
A selective review of child psychiatric syndromes with a somatic presentation.
Br J Psychiatry, 161 (1992), pp. 759-773
[26.]
I.S. Davison, C. Faull, A.R. Nicol.
Research note: temperament and behaviour in six years old with recurrent abdominal pain: a follow up.
J Child Psychol Psychiatry, 27 (1986), pp. 539
[27.]
A.M. Kriechman.
Siblings with somatoform disorders in childhood and adolescence.
J Am Acad Child Adolesc Psychiatry, 26 (1987), pp. 226-231
[28.]
M.E. Garralda, D. Bailey.
Psychosomatic aspects of children' s consultations in primary care.
Arch Psychiatry Neurol Sci, 236 (1987), pp. 319-322
[29.]
L.S. Walker, J. Garber, J.W. Green.
Somatic complaints in pediatric patients: a prospective study of the role of negative life events, child social and academic competence and parental somatic symptoms.
J Consult Clin Psychol, 62 (1994), pp. 1213-1221
[30.]
H.W. Bain.
Chronic vague pain in children.
Pediatr Clin North Am, 21 (1974), pp. 991-1000
[31.]
F. Sirol.
Los dolores abdominales recurrentes de la última infancia y de la adolescencia.
Tratado de Psiquiatría del niño y el adolescente T 4, 1.a ed, pp. 289-295
[32.]
D.N. Simon.
Russell G: Abdominal migraine: A childhood syndrome defined.
Cephalalgia, 6 (1986), pp. 223-228
[33.]
M. Lewis.
Recurrent nonorganic pain: current concepts.
Child and Adolescent Psychiatry. A comprehensive textbook, 1.a ed, pp. 1037-1041
[34.]
C.A. Astrada, W.L. Licamele, T.L. Walsh, E.S. Kessler.
Recurrent Abdominal pain in children and associated DSM-III diagnoses.
Am J Psychiatry, 138 (1981), pp. 667-688
[35.]
M. Cruz, L. Amat, I. Claret.
Dolor abdominal. En: Tratado de Pediatría, 7.a ed.
pp. 1089-1105
[36.]
J.R. Hamilton.
Dolor abdominal recidivante. En: Nelson, Tratado de Pediatría, 14.a ed.
pp. 1202-1203
[37.]
Arias Molina, I. Polanco Allué.
Dolor abdominal recurrente.
Manual de Gastroenterología Pediátrica, 2.a ed, pp. 151-161
[38.]
J. Garber, L.S. Walker, J. Zeman.
Somatization symptoms in a community sample of children and adolescents: Further validation for the Children' s Somatization Inventory.
J Consult Clin Psychol, 3 (1991), pp. 588-595
[39.]
T.M. Achenbach, C. Edlebrock.
Manual for the Child Behavior Checklist and revised Child Behavior Profile.
[40.]
L.S. Walker, J.W. Greene.
The Functional Disability Inventory: measuring a neglected dimension of child health status.
J Pediatr Psychol, 16 (1991), pp. 39-58
[41.]
M. Kovacs.
Rating scales to assess depression in school-aged children.
Acta Paedopsychiatr, 46 (1980), pp. 305-315
[42.]
C.D. Spielberger.
Manual for the State-Trait Anxiety Inventory for Children.
[43.]
H.I. Mc Cubbin, J.M. Patterson, L.R. Wilson.
Family Inventory of Life Events.
Family inventories,
[44.]
A.S. Masten, N. Garmezy, A. Tellegen, D.S. Pellegrini, K. Larkin, A. Larsen.
Competence and stress in school children: The moderating effects of individual and family qualities.
J Child Psychol Psychiatry, 29 (1988), pp. 745-764
[45.]
S. Harter.
The perceived competence scale for children.
Child Development, 53 (1982), pp. 87-97
[46.]
E.L. Gesten.
A health resources inventory: The development of a measure of the personal and social competence of primarygrade children.
J Consult Clin Psychol, 44 (1976), pp. 775-786
[47.]
L.R. Derogatis, K. Rickets, A.E. Rock.
The SCL-90 and the MMPI: A step in the validation of a new report scale.
Br J Psychiatry, 128 (1976), pp. 280-289
[48.]
H. Locke, K. Wallace.
Short marital adjustment and prediction tests: Their reliability and validity.
Marriage and Family Living, 21 (1959), pp. 251-255
[49.]
C.J. Holahan, R.H. Moos.
The quality of social support: Measures of family and work relationships.
Br J Clin Psychol, 22 (1983), pp. 157-162
[50.]
A.G. Halberstadt.
Family socialization of emotional expression and nonverbal communications styles and skills.
J Pers Soc Psychol, 51 (1986), pp. 827-836
[51.]
L.S. Walker, J.L. Zeman.
Parental response to child illness behavior.
J Pediatr Psychol, 17 (1992), pp. 49-71
[52.]
J.R. Gutiérrez-Casares, A. Perez Rodríguez, T. Martínez Rey.
Dolor abdominal recurrente & Psiquiatría. 1.er Foro de Pediatría Extrahospitalaria en Extremadura.
Badajoz, (1998),
[53.]
J.W. Finney, K.L. Lemanek, M.F. Cataldo, H.P. Katz, R.W. Fuqua.
Pediatric psychology in primary health care: brief targeted therapy for recurrent abdominal pain.
Behav Ther, 20 (1989), pp. 283-291
[54.]
M.R. Sanders, M. Reggetz, M. Morrison, W. Bor, G. Gordon, M. Dadds.
Cognitive-behavioural treatment of recurrent nonspecific abdominal pain: an analysis of generalisation, maintenance, and side effects.
J Consult Clin Psychol, 57 (1989), pp. 294-300
[55.]
Sanders Mr, Sheperd RW, Cleghorn G, Woodford H. Treatment of recurrent abdominal pain in children: a controlled comparison of cognitive behavioural family intervention and standard pediatric care: J Consult Clin Psychol; 62: 306-314
[56.]
A.J. Richsteimeier, D.B. Waters.
Somatic symptoms as a family mith.
Arch J Dis Child:, 138 (1984), pp. 855-856
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