Background & Aims

Painful disorders of the gut-brain interaction (DGBIs) are estimated to occur in up to 25% of youth worldwide. DGBIs include multiple gastrointestinal pain-related conditions of which the symptoms cannot be fully attributed to an identified medical/organic cause. Observers tend to react with uncertainty and confusion to people whose pain is not clearly medically understood. As a result, children with DGBIs are prone to the stigmatizing reactions of others. Previous research suggests that stigmatization has negative consequences on mood, sleep, and pain outcomes. This study examined whether the association between stigma and abdominal pain severity can be explained by depressed mood and sleep disturbances in children with DGBIs.

Methods

We recruited 115 treatment seeking children (72% female, 77% White, Agemean =13.6 years) who met Rome IV criteria for a DGBI including functional dyspepsia (44%), irritable bowel syndrome (33%), abdominal migraine (2%), and functional abdominal pain-NOS (24%). Child participants reported the severity of their abdominal pain as well as their experiences of depressed mood and sleep disturbances using pediatric versions of the Patient-Reported Outcomes Measurement System (PROMIS).They then completed the Felt Stigma subscale of the Health-Related Felt Stigma and Concealment measure. Data analysis was conducted using T-scores for all PROMIS measures. Primary analysis was completed via a sequential mediation model controlling for covariates (age, race, sex) using 95% bootstrapped confidence intervals.

Results

Results revealed that greater felt stigma was significantly associated with greater abdominal pain severity (r = .214, p = .024). The indirect effect of felt stigma on abdominal pain severity through both depressed mood and sleep disturbances was significant with a point estimate of .879 and a 95% confidence interval of .056 to 1.947. Specifically, greater felt stigma was significantly associated with greater depressed mood (t??=??7.426, p?<?.001). Greater depressed mood was significantly associated with greater sleep disturbances (t??=??5.184, p?<?.001); in turn, greater sleep disturbances were associated with greater abdominal pain severity (t??=??2.485, p??=??.015) for children with DGBIs.

Conclusions

Findings suggest that children’s experiences of stigma in the context of DGBIs may perpetuate depressed mood, which can lead to sleep disturbances. In turn, depressed mood and sleep disturbances may exacerbate the abdominal pain severity of children with DGBIs. These findings are important because stigma-related worsening of mood, sleep, and chronic pain is likely to impede appropriate DGBI management and retention in care.

References

Drossman, D. A., & Hasler, W. L. (2016). Rome IV—functional GI disorders: disorders of gut-brain interaction. Gastroenterology, 150(6), 1257-1261.
Drossman, D. A., & Tack, J. (2022). Rome Foundation clinical diagnostic criteria for disorders of gut-brain interaction. Gastroenterology, 162(3), 675-679.
De Ruddere, L., & Craig, K. D. (2016). Understanding stigma and chronic pain: a-state-of-the-art review. Pain, 157(8), 1607-1610.
Wakefield, E. O., Zempsky, W. T., Puhl, R. M., & Litt, M. D. (2018). Conceptualizing pain-related stigma in adolescent chronic pain: A literature review and preliminary focus group findings. Pain Reports, 3(Suppl 1).
Wakefield, E. O., Belamkar, V., Litt, M. D., Puhl, R. M., & Zempsky, W. T. (2022). “There’s nothing wrong with you”: Pain-related stigma in adolescents with chronic pain. Journal of Pediatric Psychology, 47(4), 456-468.
Boileau, N. R., Thompson-Phillips, K. A., Goodin, B. R., Lynch-Milder, M. K., Evans, C. T., Adetayo, T., … & Wakefield, E. O. (2023). Pain-Related Stigma and Its Associations With Clinical and Experimental Pain Severity in Youth With Chronic Musculoskeletal Pain Conditions. Journal of pediatric psychology, 48(10), 842-851.

Presenting Author

Burel R. Goodin

Poster Authors

Burel Goodin

PhD

Washington University in St. Louis

Lead Author

Tolulope Adetayo

M.A.

University of Alabama at Birmingham

Lead Author

Corinne Evans

M.A.

University of Alabama at Birmingham

Lead Author

Divya Patel

University of Alabama at Birmingham

Lead Author

Aaron Fobian

PhD

University of Alabama at Birmingham

Lead Author

Reed Dimmitt

MD

University of Alabama at Birmingham

Lead Author

Marissa Gowey

PhD

University of Alabama at Birmingham

Lead Author

Topics

  • Pain in Special Populations: Adolescents