There is no pathognomonic personality profile of a child or adolescent presenting with psychogenic pain symptoms. However, most are described as anxious and sensitive, with a tendency towards being fearful, inhibited, and overcontrolled. These children often have a family history of abdominal pain. Some researchers have speculated that the determining factor for symptom formation may not be the level of emotional tension in the RAP children but their manner of coping. Aetiology and Pathogenesis Neuropsychobiological mechanisms for pain have been postulated.
Peripheral fibres transmit the impulses afferently to cell bodies in the dorsal root ganglia.
Through synapses in the dorsal horn of the spinal cord, via the spinothalamic and other tracts, impulses are conveyed to synapses in the thalamus and brainstem. From these secondary neurons, fibres terminate in the subcortical areas, limbic system, and postcentral gyrus of the cortex. Perceptual inputs from the higher brain functions may actively influence the site and experience of pain although the exact pathways of such higher inputs are not understood. There may be some genetic loading in some families where the symptom is reproduced from the generation to the next, with conditioned reflexes possibly playing a part in the triggering mechanisms referred to above. Psychological Theories Family Recurrent abdominal pain is usually part of the child s pattern of reaction to emotional stress, often reflecting a family pattern.