Catastrophizing Mediates Pain Scores Through Anxiety and Disability in Pediatric IBD

Among pediatric patients with IBD, pain catastrophizing mediated abdominal pain and functional disability, even in the absence of active disease.

 Among adolescents with inflammatory bowel disease (IBD), pain catastrophizing was found to mediate the relationship between abdominal pain and both anxiety and functional disability. These findings were published in the Clinical Journal of Pain.

This study is a secondary analysis of data from a randomized controlled trial that implemented a problem-solving skills training intervention to promote medication adherence delivered over the telephone. For this mediation analysis, the relationship between Abdominal Pain Index (API), Pain Catastrophizing Scale-Child Version (PCS-C), Revised Children’s Anxiety and Depression Scale (RCADS), and Functional Disability Inventory (FDI) scores were evaluated.

A total of 76 adolescents were included in this study. The mean age of study participants was 14.71 (standard deviation [SD], 1.80) years, 42% were girls, 86% were White, 72% had Crohn disease, 70% were in remission, and mean duration of time since diagnosis of IBD was 43.52 (SD, 38.64) months.

The study population had an average API total Z-score of 1.97 (SD, 0.21), PCS-C total score of 11.81 (SD, 10.21), RCADS total anxiety score of 11.68 (SD, 10.71), RCADS low mood subscale of 3.34 (SD, 3.43), and FDI total score of 2.11 (SD, 4.86).

[P]atients with better coping may in turn experience less rumination and magnification, which may reduce symptoms of pain.

In the primary mediation analysis, API scores at baseline had an indirect effect on RCADS anxiety scores at week 20 through PCS-C scores at week 12 (β, 1.61). Similarly, API scores at baseline had an indirect effect on FDI scores at week 20 through PCS-C scores at week 12 (β, 0.77). In addition, API scores had a direct effect on PCS-C scores (β, 1.17).

In the secondary analyses, when RCADS anxiety scores at week 20 were set as the dependent variable, API scores at baseline had an indirect effect through PCS-C rumination subscale scores at week 12 (β, 1.08) and through PCS-C magnification subscale scores at week 12 (β, 1.65).

When FDI total scores at week 20 were set as the dependent variable, API scores at baseline had an indirect effect through PCS-C rumination subscale scores at week 12 (β, 1.36) and PCS-C helplessness subscale scores (β, 0.75).

A limitation of this study is that the design of the original study did not have objectives to assess IBD pain outcomes.

These data indicate that among pediatric patients with IBD, pain catastrophizing mediates abdominal pain and functional disability even in the absence of active disease. However, additional study is needed to evaluate the effectiveness of pain catastrophizing interventions in the setting of pediatric IBD. The authors state that “patients with better coping may in turn experience less rumination and magnification, which may reduce symptoms of pain.”

This article originally appeared on Clinical Pain Advisor

References:

Feldman ECH, Lampert-Okin SL, Greenley RN. Relationships between abdominal pain, mental health, and functional disability in youth with inflammatory bowel diseases: pain catastrophizing as a longitudinal mediator. Clin J Pain. 2022;38(12):711-720. doi:10.1097/AJP.0000000000001077