This pack has been produced with by Frimley Health NHS Trust in partnership with Healthier Together
This pack is aimed at children and young people who have long lasting abdominal (tummy) pain. When a physical cause cannot be seen on a test or a scan, it is called ‘Functional pain’, because it affects your functioning (what you are able to do).
Most pain is like a warning, it is your body’s way of telling you that you are either hurt, or about to be hurt. This warning allows you to do something to prevent further pain. For example, when you touch something hot, the pain makes you move your hand to stop you burning yourself.
After you have injured yourself, e.g. if you break your leg, your brain can keep sending pain messages for a while, even when things have healed. The pain does not mean that your leg is still damaged.
So, sometimes, pain sticks around longer than it needs to and sometimes there is no actual injury or problem causing the pain, but it is still definitely real. The usual medical treatment of pain relief does not work very well for this kind of pain. When this happens, the brain seems to be confused, sending pain messages when it doesn’t need to!
Living with pain can be difficult. It can affect the things you do, it can also impact the way you feel and think, as well as your relationships with friends and family.
Have a look at the examples below of how pain can affect young people. Use the blank spaces to write other ways in which pain has affected your life.
For a printable version of this worksheet, click here.
Functional abdominal pain is a type of chronic pain, it is relatively common and reported in up to 18% of young people. It is a condition where children and young adults experience frequent periods of abdominal (tummy) pain over an extended period. Chronic means lasting more than a few weeks.
Functional means that there is no physical blockage, infection or inflammation causing the pain. Nevertheless, the pain is real and can be distressing for both children and adults. Like all pain, abdominal pain can affect your thoughts, feelings, and behaviour in many situations.
Children with functional abdominal pain often experience pain in the stomach or bowel area. They usually do not have any other signs of illness, such as a temperature, weight loss, or blood in their poo. Sometimes the pain may be associated with episodes of diarrhoea and constipation, or vomiting, but this is not the cause of the pain.
Functional abdominal pain is sometimes associated with other symptoms such as headaches, limb pain, and sleep disturbances.
The exact cause of functional abdominal pain is largely unknown, although the condition has been studied a lot by researchers and medical professionals. Many practitioners agree that biological and psychological factors interact to maintain the pain; it is possible that pain is due to overly sensitive nerves in the gut. The gut has a massive network of nerves which send signals to the brain when we are hungry, full, or ill. This is called The Gut-Brain Axis. Sometimes these messages can be influenced by things outside the gut and misinterpreted by the brain. For example, it is common for children and young adults to not feel hungry on the morning of an exam. Others may need to vomit, or visit the toilet frequently.
The symptoms are real and are especially difficult to manage in stressful or anxiety-provoking situations, but it is important to remember that they are not caused by a physical disease.
The sensation of pain is affected by both physical and psychological processes. Signals from nerve endings in the nervous system passes through a neural ‘gate’ in the spinal cord before being passed to the brain. The ‘gate’ is what determines how much pain we feel. The more open the gate is, the more pain we feel. Factors that open the gate:
Focusing on the pain – Pain can feel worse when we concentrate on it a lot.
Lack of Activity – Not moving or and stopping our normal activities can make pain worse. It can also reduce our fitness levels.
The more closed the gate is, the less pain we feel. Factors that close the gate:
Long-term pain can create a cycle in which we feel trapped. The first step to breaking out of the pain cycle is to understand what it is! By understanding the pain cycle, we can start to see that there are several things that can be done to help manage your pain.
As you can see, pain can affect you in many ways. It affects your thoughts, feelings, body, and behaviour. Therefore medication does not work as well for chronic/long-term pain, as it focuses on the physical symptoms. It is important to think about thoughts, feelings, and behaviours too as they all affect the experience of pain.
Some people who suffer with long-term abdominal pain choose to do less activity. This makes sense; however, it can result in you missing out on important and fun activities. However, we know that missing out can negatively impact your mood. Some people try to stay very active on days they feel better. Again, this approach makes sense but can be counterproductive. You may push yourself too hard and end up suffering, resulting in exhaustion and low mood. This is referred to as a boom-and-bust pattern:
Pacing is a skill which enables you to consistently carry out activities without causing excessive tiredness or inactivity. Pacing is the middle ground between doing nothing and doing too much. Over time you may notice that pacing enables you to do more.
For a printable version of this worksheet, please click here.
When we experience abdominal pain, we can often stop doing things that we used to enjoy. However, avoiding things often makes us feel worse in the long-term.
Create a ladder (hierarchy) of things you avoid with the ones you are most anxious about at the top, and the ones that bother you less at the bottom. Try to include a good mix of the things you wrote down in Section 1. Start to tackle your fears and your abdominal pain by starting at the bottom of the ladder and gradually working your way through each step. Before completing each task, write down what you think will happen, and follow this up by writing down what happened after task completion. Hopefully you will start to see that it is mostly not as bad as you think it is going to be.
For a printable version of this exercise, please click here.
Having abdominal pain can cause you to stop taking part in activities you enjoy. Goal setting is about working out what you would like to be able to do, and working towards achieving it. Goal setting is a powerful way of improving your quality of life and sense of control. It is important that goals are meaningful to you and feel good.
A goal is something that you are motivated to work towards and achieve. When you are working on activity levels, it is important to set goals that can help to both motivate you, as well as direct your efforts and energy.
To create a specific goal it must answer the 6 ‘W’s.
‘I want to use Progressive Muscle Relaxation to help manage my pain’ as a SMART goal would be:
‘I want to use Progressive Muscle Relaxation 30 minutes, everyday at home for one month, to reduce my symptom severity’.
Measurable goals make it easier to stay on track to meeting your goals. Questions like ‘how much’, or ‘how many’, or ‘how will I tell if I met my goal’ is a good way to determine what to measure. For example, practicing Progressive Muscle Relaxation for 30 minutes everyday is quantifiable and measurable. You can track your progress and see results.
When you are coping with abdominal pain you need to have goals which are realistic and reasonable. It is easy to get ahead of yourself. Sometimes people fall into the trap of getting overwhelmed by goals which seem impossible. Make a realistic goal by breaking into smaller goals.
An important factor in achieving your goals is seeing the progress you have made. Set a time limit to complete your goal. For example, practice progressive muscle relaxation for 30 minutes each day, for a month before you tackle another goal. Write down your progress, seeing progress can motivate and encourage you.
Mood can be greatly affected by what we do, when we do it, and with whom.
Keep track of what you do each day and make sure you are spending your time doing enough things that give you a sense of:
Being mindful of these 3 things when goal setting may help you to set meaningful SMART goals. Doing more also allows less time for negative and unhelpful thoughts and overthinking, which will have a positive effect on mood.
Calming The Body - Feeling relaxed can help reduce symptom severity
Progressive Muscle Relaxation (PMR)
Muscle tension is commonly associated with stress and anxiety, it is the body’s natural response to potentially dangerous situations. Even when there is no danger, our bodies can still respond in the same way. You may not always realise that your muscles are tense, it may be as subtle as your jaw clenching, or as obvious as your shoulders feeling tight and hunched. PGR is a deep relaxation technique which is based upon the simple practice of tensing one muscle group at a time . This is followed by a relaxation phase with release of tension. This is very useful before bedtime.
During deep breathing your blood is oxygenated, triggering the release of endorphins, whilst also decreasing the release of stress hormones, and slowing down your heart rate.
Calming The Mind - Strategies for managing the anxiety and stress that is often associated with abdominal pain
Worry Trees are helpful in reducing levels of anxiety surrounding both hypothetical situations and current problems.
Help yourself to feel more relaxed by thinking about things that make you feel calm and rested. For example, picturing your favourite place. This can be either independent, or you can take a guided visualisation approach. A guided visual imagery relaxation task has been provided in this pack.
Safe Place Visualisation
A powerful stress reduction and relaxation tool, that can be applied at any time, in any location.
This is a useful technique for remaining grounded in the present, to alleviate symptoms of stress and anxiety.
Developing Coping-Self Talk
These are phrases that you can say to yourself that are supportive. For example “Just because it has happened before it does not mean it will happen again”
Other pain resources:
Other useful websites: