The nature of chronic pain may interfere with detection of a comorbid ED.
Reprinted from Eating Disorders Review
May/June Volume 27, Number 3
Chronic pain can affect eating patterns in various ways, leading to changes in appetite, erratic meals, vomiting, and decreased activity. Dr. Leslie A. Sim and colleagues at the Mayo Clinic recently reported that eating disorders may be overlooked in teens with chronic pain, leading to a poorer prognosis (J Pediatr Health Care. 2016 doi: 10.1016/j.pedhc.2016.03.001. [Epub ahead of print].
In their study of 34 adolescents with chronic pain and concurrent EDs and 34 age-, gender-, and ED-symptom-matched teens who had an eating disorder but no pain, Dr. Sim and co-workers reported that chronic pain, abdominal pain, autonomic dysfunction, and headache were nearly always diagnosed before the eating disorder was detected. Forty-one percent of the teens with chronic pain reported that their eating disorder developed after their chronic pain, while 35% had ED symptoms before chronic pain developed.
Detection of the eating disorder was delayed in adolescents with chronic pain compared with teens with EDs but no chronic pain. Several factors may account for this. For example, the complaints about the pain may receive more focus. Also, abdominal pain, for example, may give patients with eating disorders a more acceptable excuse for restricting food. Of note, a third of the teens had the postural orthostatic tachycardia syndrome, or POTS, with lightheadedness, headaches, dizziness, fatigue and/or abdominal discomfort, further confusing the picture. The authors offer several steps to help detect eating disorders in these patients.
Take a history of eating behavior, and review the symptoms
Obtaining a clear history of eating behavior and evaluating adolescents for ED symptoms are critical for intervention, according to the authors. In the 34 teens with chronic pain and EDs, the most common diagnosis was anorexia nervosa (AN). This contrasted with typical findings from both community and clinical samples, where AN is often the least commonly diagnosed eating disorder. This could mean that AN is more prevalent in patients with chronic pain, but Dr. Sim and colleagues suggest this is more likely to be due to a detection bias. Marked weight loss may draw attention to patients with AN, and may not be a true representation of the relative prevalence of eating disorder diagnoses in the population with chronic pain.