Identifying potential pediatric chronic abdominal pain triggers using ecological momentary assessment.

The purpose of this study was to evaluate associations between pediatric chronic abdominal pain and a variety of presumed triggers for abdominal pain in real-time. Associations were explored at the level of patient self-perception and empirically across the group. Thirteen patients (8 to 17 years) presenting for initial subspecialty evaluation of chronic abdominal pain at a large Midwestern children’s hospital were asked to complete an electronic diary questionnaire on a handheld mobile device 3 times daily for 14 days. This questionnaire assessed for the presence/absence of pain and a wide variety of presumed triggers for abdominal pain. Participants also completed a survey at preand postmonitoring that asked them to check off whether they believed that any of the presumed triggers were actual triggers for them personally. Participants self-identified a few pain triggers consistently across the group. Group-based analyses of diary data revealed several predictive relationships, including some not consistently self-identified by participants. Several variables (e.g., acute illness, drinking soda, eating spicy or fried foods, consuming seafood, nuts, or chocolate, experiencing negative affect, getting fewer hours of sleep, and increased pollen count) appear reliably associated with onset of pain across individuals from among the array of presumed triggers investigated. Clinical treatment for pediatric chronic abdominal pain should include consideration and discussion of these triggering relationships. Future work in this line of research may help to support the development of personalized treatment approaches for this complex condition.