![]() This perspective suggests that pediatric abdominal pain patients may differ from well children in the way that they appraise and cope with stress, and, moreover, their particular style of stress appraisal and coping may be associated with high levels of symptoms and disability. Theories of life stress emphasize that the manner in which individuals appraise and cope with stress determine the impact of stress on health ( Lazarus & Folkman, 1984 Monroe & Kelly, 1995 Sandler, Wolchik, MacKinnon, Ayers, & Roosa, 1997). Investigation of pain patients’ subjective experience and behavioral responses to stress might shed light on the relation between stress and somatic symptoms observed in these patients. Moreover, results of a diary study showed that the intraindividual relation between daily stressors and somatic symptoms was significantly stronger in abdominal pain patients than in well children ( Walker, Smith, Garber, Van Slyke, & Claar, 2001). In prospective studies, higher levels of negative life events predicted symptom maintenance 3 months ( Walker & Greene, 1991) and 1 year ( Walker, Garber, & Greene, 1994) following children’s medical evaluation for abdominal pain. ![]() Several investigations have linked chronic abdominal pain to stressful life events. It is rarely associated with organic disease, but instead typically reflects a functional gastrointestinal disorder ( Boyle, 1997 Walker, et al., 2004). Chronic abdominal pain, defined as long-lasting intermittent or constant abdominal pain ( American Academy of Pediatrics and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, Subcommittee on Chronic Abdominal Pain, 2005), affects 5–20% of youth ( Apley & Naish, 1958 Kristjansdottir, 1997 Oster, 1972), is associated with high levels of impairment and pediatric health service utilization ( Campo, Comer, Jansen-McWilliams, Gardner, & Kelleher, 2002), and may continue into adolescence and adulthood ( Campo et al., 2001 Walker, Guite, Duke, Barnard, & Greene, 1998).
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