Study Finds Multiple Brain Regions Associated with Abdominal Pain in Children

June 28, 2022

Children who experience functional abdominal pain (FAD) disorders have enhanced connectivity between the amygdala, a region implicated in emotional processing, and multiple brain regions associated with pain and cognition, a Michigan State University study found.

FAD is pain that cannot be explained after thorough physical examination and appropriate testing. Because it is the most common complaint of children and adolescents who are seen by gastroenterologists, the finding is significant.

This study demonstrates that the brains of children who suffer from functional abdominal pain operate differently than the brains of children who do not, said Natoshia Cunningham, PhD, assistant professor in Michigan State University College of Human Medicine Department of Family Medicine, who led the study.

Cunningham’s study, published in PAIN, the journal of the International Association for the Study of Pain, also showed enhanced connectivity between similar brain regions in youth with functional abdominal pain disorders following a painful task.

While abdominal pain in children can be difficult to diagnose and challenging to treat, “this shows patients, families and providers the pain is real,” said Cunningham, a pediatric psychologist.

The study used functional magnetic resonance imaging, or fMRI, to examine neural activity in the brains in 25 children, ages 11 to 17, who suffered functional abdominal pain disorders. These data were compared with data from the brains of 20 healthy children. The results showed that, unlike the healthy children, those who had abdominal pain generally experienced increased connectivity between the amygdala, the area of the brain where emotions are experienced, and other areas related to processing pain and cognition.

The study also showed similar results when the children who suffer from functional abdominal pain drank enough water to induce mild abdominal discomfort and pain. The changes that the researchers saw in the neuroimaging data after completing the task correlated to actual changes the patients reported in their pain symptoms, Cunningham said.

Around 10% of children suffer from a functional abdominal pain disorder, such as irritable bowel syndrome, Cunningham said, adding that the number of cases and intensity of pain may have increased during the COVID-19 pandemic. For several patients, the pain is generally worse during the school year.

“What I have found is that about 50% of kids who have functional abdominal pain tend to have high anxiety, and that can make pain worse,” Cunningham said.

While some children eventually outgrow the pain, a large portion (30%) do not, she said, and they may be at risk for developing other painful conditions, mental health problems, and academic difficulties, including school absences, and, in some cases, can even fail to graduate.

“It can be really debilitating and have a long-term impact,” Cunningham said.

Eventually, she hopes such research leads to the discovery of biomarkers, such as through blood or saliva tests, to diagnose functional abdominal pain disorders quickly.

With funding from the National Institutes of Health, Cunningham developed a tailored cognitive behavioral therapy to help children with functional abdominal pain deal with anxiety and manage their pain called Aim to Decrease Anxiety and Pain Treatment, or ADAPT, and found this approach to be effective.

Working with a team of clinicians at Helen DeVos Children’s Hospital, she is now testing whether ADAPT changes the hyper-connectivity she has observed between the amygdala and other regions implicated in pain in youth with functional abdominal pain disorders.

“My goal is to see if an effective treatment can normalize the function in those areas of the brain,” Cunningham said.