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What is pain?
This information 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 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!
How Does Your Pain Affect You?
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:
- Struggle to keep up with school work
- Stop doing Hobbies
- Cannot Concentrate
- Struggling to sleep
- Feeling upset and frustrated
- Reduced fitness
- Cannot participate in sports
- Cannot go out with friends
Functional Abdominal Pain
What Is Functional Abdominal Pain?
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 of time.
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.
What Are The Symptoms Of Functional Abdominal Pain?
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.
What Causes Functional Abdominal Pain?
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 Pain Gate
The sensation of pain is affected by both physical and psychological processes. Signals from nerve endings in the nervous system pass 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:
- Stress and Tension – All sorts of emotional states can lead to the gates to pain being more open. These include being anxious, worried, angry, and sad. Having a lot of tension in the body is a common way of opening the pain gates.
- 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:
- Relaxation and Contentment – Feeling generally happy and optimistic has been found to help close the pain gate.
- Psychological Factors - Feeling relaxed and content, possibly by doing relaxation exercises keeping your mind busy and distracted with other things, and focusing your attention on doing things that are important to you (rather than focusing on the pain and gloomy thoughts associated with it).
- Activity – Being active but not overdoing it so you develop your fitness.
- Other Physical Factors – some types of counter-stimulation (heat, massage, and acupuncture) may help.
Opening and Closing The Pain Gate
| Factors | Things That Open The Pain Gate, Causing Pain. | Things That Close The Pain Gate, Reducing Pain. |
| Physical |
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| Activity/Behaviour |
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(See Pacing) |
| Emotional/Feelings |
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| Thoughts |
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| Social |
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The Pain Cycle
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 actually is! By understanding the pain cycle, we can start to see that there are a number of things that can be done to help manage your pain.
Pain 
As you can see, pain can affect you in many different ways. It affects your thoughts, feelings, body, and behaviour. This is why 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.
Changing How I Cope With Pain: Doing Too Much or Too Little
Pacing
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.
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.
- Choose an activity, such as seeing your friends or school work.
- Measure the length of time you feel physically and emotionally comfortable doing this. Do this at least 3 separate times on good and bad days.
- Take the average of these times. This helps you find your comfortable starting point (amount of time) to spend on these activities. Try to stick to this time, no more and no less.
Remember:
- Pacing can give you more control.
- Pacing is about judging when to stop an activity based on time and not mood.
- The comfortable starting point should be used on both good, and bad days. It is normal to find it difficult to limit yourself on good days.
- Using a comfortable starting point leads to improved tolerance and achievement.
Planning Future Goals
- Consider areas that you want to change or improve.
- Try to set goals you are capable of achieving using determination. Do not underestimate your ability!
- Have faith in yourself - your thoughts can affect how you physically feel!
- Write down your goals. It will help you to see what you have achieved.
- Do not panic if you do not achieve your goal. Think about why. Perhaps you need to add in a smaller step to achieve the long term goal?
- Reward yourself when you achieve a goal!
Smart Goals
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.
Specific: clearly state what you would like to happen
Measurable: will you be able to say it was achieved?
Achievable: are you able to complete the task independently?
Realistic: are you going to do it?
Timely: think whether it is ‘the right time’ to do this. Set yourself a realistic time limit to achieve this goal.
Specific
To create a specific goal it must answer the 6 ‘W’s.
- WHO is this goal for/who is involved in it?
- WHAT is it that needs to be accomplished?
- WHERE should this goal take place?
- WHEN will this goal be completed, or how long will it take?
- WHICH things or requirements, and constraints, need to be identified?
- WHY does this goal need to be accomplished? What is its purpose?
For example:
‘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
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.
Realistic
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.
Timely
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.
Doing more
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:
A - achievement
C – closeness to others
E – enjoyment
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.
Progressive Muscle Relaxation
| 1 | Get comfortable in a distraction free environment. You can either lay down or sit upright in a chair. Closing your eyes will help you focus on the different muscle groups, but you do not have to if you don’t want to! For all steps, hold the tense position for a couple of deep breaths, or however long is comfortable for you, then relax. Repeat each step three times. |
| 2 | Draw a deep breath in through your nose and feel your abdomen rise as you fill your body with air. Then slowly exhale from your mouth, pulling your belly-button towards your spine. |
| 3 | Start with your feet. Clench your toes with your heel pressing towards the ground. Squeeze tightly for a couple of breaths and then release. It may help to say ‘relax’ whilst you release the tension. Next, flex your feet with your toes pointing towards your head. |
| 4 | Next move to your legs. Stretch your leg out, with your toes pointing towards the sky, feel the back of your leg tightening. Hold this for a couple of deep breaths and then release. Then, point your toes down into the ground with your leg straight for a couple of deep breaths. |
| 5 | Now move onto your glutes. Squeeze your buttocks muscles for a couple of deep breaths. Remember, you should only feel tension and not pain. |
| 6 | Breath in deeply, filling up your chest and lungs with air. To tense your stomach and chest, pull your belly button in towards your naval as tight as you can. |
| 7 | Next, tense your shoulder blades and back. Push your shoulder blades backwards, as if you are trying to get them to touch. This will push your chest forwards. |
| 8 | Now tense the muscles in your shoulders as you bring your shoulders up towards your ears. |
| 9 | Be careful when tensing your neck muscles! Face forward, and SLOWLY pull your head back to look up at the ceiling. |
| 10 | Squeeze your teeth together to tense your jaw. Open your mouth as wide as you can, as if you are yawning, to relax your mouth and jaw. |
| 11 | To tense your eyes and cheeks, squeeze your eyes tight shut. |
| 12 | Raise your eyebrows as high as they will go, as if you were surprised, to tense your forehead. |
| 13 | To tense your upper arms, bring your forearms up to your shoulder to ‘make a muscle’. |
| 14 | Finally, to tense your hand and forearm, make fists with both of your hands. |
Practice means progress. Only through practice can you become more aware of how your muscles respond to tensions and relaxation. Training your body to respond differently to stress is like any training – practice is the key!
Calming The Body: Deep Breathing
During periods of anxiety, the body triggers the Fight or Flight Response. Breathing is shallow, uncontrolled, and muscles become tense. Deep breathing triggers the Relaxation Response, whereby breathing becomes deeper, controlled, slower, and the symptoms of anxiety reduce.
| Sit or lie down comfortably. Close your eyes if it makes you feel more comfortable. Place your hand on your stomach, if you breath deeply enough, you should notice your hand rising and falling with each inhalation and exhalation. Imagine a balloon blowing up in your stomach as you breath in, and deflating as you breath out. |
 |
Inhale. Breathe in slowly through your nose for 4-8 seconds. |
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Pause. Hold the air in your lungs for 4- 8 seconds (however long is most comfortable for you). |
 |
Exhale. Breathe out slowly through your mouth for 4-8 seconds. |
Repeat. Practice for at least 2 minutes. As your technique improves, practice for 5-10 minutes.
- Slow down. The most common mistake is breathing too quickly. Count each step slowly as you do so.
- Counting your breaths takes your mind off of the source of anxiety. Counting acts as a distraction, whenever you catch your mind wandering, return to counting.
Relaxing Safe Place Imagery
All visualisations can be strengthened by engaging all of your senses in creating your ‘Safe Place’. If you any negative thoughts enter your positive imagery, discard that image and create another one.
Get comfortable in a quiet place where you won’t be disturbed. Sit, or lie, comfortably. Take a few minutes to practice some deep breathing, become aware of any tension in your body, and release it with each breath.
Imagine a place where you can feel safe and relaxed. Your safe place can be somewhere you have been on holiday, somewhere you have seen a picture of, or a completely new place you create. Avoid using your home as your safe place.
Look around your safe place, pay attention all the colours and shapes around you. Describe what you see aloud.
Now focus on what you can hear. Listen to the sounds far away from you, and those close to you. Perhaps you hear is silence. You may hear the sound of running water, or the crunch of leaves under your feet.
Now focus on any skin sensations. Notice the feel of the ground beneath your feet, or whatever is supporting you in this place. Pay attention to the temperature and direction of the wind, and anything else you can feel.
Take a deep breath in. Place your hand on your stomach, and imagine a balloon inflating in your stomach. Can you notice any smells there? Maybe you can taste the salty sea air as you inhale?
Pay attention to all of these sensations whilst you spend time relaxing in your safe place.
Whilst you’re in your safe place, give it a name that you can use to bring that image back at any time.
You can choose to stay for a while, enjoying the calmness and tranquillity. You can leave when you are ready by slowly opening your eyes and bringing yourself back to alertness in the present.
Self-Soothing
5, 4, 3, 2, 1 Grounding Technique
This approach explores your five senses to help keep you grounded in the present. This is a calming technique that can help you get through periods of anxiety, or pain. It can be done independently, making it useful for when you are alone.
Take a deep belly breathe to begin. Imagine a balloon in your stomach filling up with air as you breath in.
LOOK: Look around for 5 things that you can see, and say them out loud. For example, you could say, I see the TV, I see the pencil case, I see a vase of flowers.
FEEL: Pay attention to your body and think of 4 things that you can feel, and say them out loud. For example, you could say, I feel my feet warm in my slippers, I feel the grass beneath my feet, or I feel the beanbag I am sitting on.
LISTEN: Listen for 3 sounds. It could be the sound of traffic outside, the sound of typing or the sound of your tummy rumbling. Say the three things out loud.
SMELL: Say 2 things you can smell. If you’re allowed to, it’s okay to move to another spot and sniff something. If you can’t smell anything at the moment or you can’t move, then name your 2 favourite smells. You may say, I can smell dinner cooking, or I can smell perfume.
TASTE: Say 1 thing you can taste. It may be the toothpaste from brushing your teeth, or sweetness from fruit. If you can’t taste anything, then say your favourite thing to taste.
Take another deep belly breath to end.
Worry Tree
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1. What is making you worry? __________________________________________________________________________________________ __________________________________________________________________________________________ |
| 2. Can I do anything about this issue? |
| NO: Try to distract myself to ease my worries. | YES: Make a mind-map or list showing what different things I can do to stop or improve my worry. |
| 3. Can I do anything about it right now? |
|
Yes I can: ______________________________ _______________________________________ |
No, I cannot do anything about it in this moment. |
| Do this now. | Make a mind-map or action plan of what I can do in the future to help ease my worry |
| Stop worrying and distract yourself. | Do my best to stop worrying by distracting myself, until I can action my plan. |
Tip: make your mind-maps and lists colourful, you will be more likely to remember what you have written, and engage with the material more!
Guided Visual Imagery Relaxation: The Beach
Lay down, or sit comfortably in a quiet room. Use the deep breathing techniques you learnt earlier in this information pack, close your eyes and listen to somebody read you the following script. You can also read this script to yourself. You may find it more relaxing to play an audio track of crashing waves on the beach; this can be sourced on YouTube, Spotify, and most other online music platforms.
You’re walking down a long wooden stairway to a big, beautiful beach. It is very quiet and stretches off into the distance as far as you can see. As you look down you notice that the sunlight is reflecting off of the golden sand. You step into the sand, it feels warm so you wriggle your toes. You notice the warmth from the sand between your toes and around your feet. You notice the sounds of the waves crashing and chasing you up the shore, the water sparkles like a diamond as it retreats back. The roaring sound of the waves is so soothing that you can just let go of any worries.
The ocean is a beautiful light blue, with patches of darker sapphire in the deep. As you look at these deep blue areas you notice a small sailboat on the horizon. All of these sights help you to let go of any worries and relax even more.
As you continue walking along the beach, you become aware of the fresh salty sea air. You look up take a slow deep breath in, and breath out. This breath makes you feel refreshed and relaxed. As you look up you notice two seagulls, the wind gusts and they appear to dance in graceful circles above you. It makes you wonder how it would feel if you could fly under the warm sun.
You find yourself settling into a deep state of relaxation as you walk further down the beach. You feel the sun wrap its warm arms around you, the warmth relaxes all of your muscles. You notice a beach chair as you walk down the beach, once you reach it you take a seat. Laying back in this comfortable chair makes you reflect on everything you have felt, seen and thought at this beach. You drift into a deeper state of relaxation.
Now, feeling relaxed and at peace, you slowly rise from the beach chair and step into the warm sand to walk home. As you walk, you remember how relaxing this beach has been, and you know that you can come back to this place anytime you like. You start to climb the wooden stairs and gradually bring yourself back into the room. When you are ready, you can open your eyes.
Develop Coping Thoughts/Positive Self-Talk
Positive statement encourage us and help us cope in distressing times. We can act as our own coach by saying encouraging things to ourselves, especially when pain is worse. Creating a sentence that you can say to yourself when you are feeling low or struggling to cope with your pain can be very useful. Some children keep a copy of these in their pencil case or wallet so that they are always available.
Some examples include:
“I can do this.”
“I can cope.”
“Keep calm and carry on.”
“Thoughts are just thoughts – they are not necessarily fact.”
“It is okay to feel this way, it is a normal reaction.”
“This is difficult and painful, but it is only temporary.”
“This wont last forever.”
Activity:
Fill in the empty spaces with a coping thought you could use in this situation:
| Situation | Coping Thought/ Positive Statement |
| Example: I have got really bad stomach pain, I am supposed to have a test at school today. | ‘The pain will pass, like it has done before. I can still go and do my best, and talk to a teacher to tell them about how I am feeling’. |
| I was supposed to go out with my friends today, but my tummy pain is bad again. | |
| I keep missing out on taking part in sports. |
Supporting Young Children and Teenagers Experiencing Functional Abdominal Pain
It can be difficult to see a child/teenager in pain. However, as an adult there are ways in which you can help improve their ability to cope with pain:
- Reassurance – Although we do not know the exact organic cause of functional abdominal pain, your doctor will have completed tests to check that there are no other concerns. It is important to reassure your child that although their symptoms of pain are real (and you understand that they are not making them up), they are not dangerous.
- Record – When you first notice pain, you may like to keep a pain diary. This may be helpful to learn about triggers and factors that make the pain better/worse. Please ask your doctor for a pain diary if you plan to see them again, and they think that this would be helpful.
- Distract and reduce focus on pain - It can be difficult to know how to respond to a child/ young adult who is in pain. Often, the natural urge is to pay attention to signs that the young person may be in pain and to reassure them. It is important to avoid making the child/ young person worry or become anxious, as they may focus on their pain more. Although it is challenging as a parent, it is important to minimise attention on the pain, for example, by not asking how pain is. When pain starts, you may find it more beneficial to help the young person focus on something other than the pain, perhaps by engaging them in something they enjoy.
- Encourage normal activities - It is important to not stop the young person doing the things they enjoy due to a fear of pain. You can reinforce ‘well behaviour’ (e.g. doing enjoyable activities) and give them confidence to resume their hobbies and interests, despite pain.
- Provide encouragement – Children and young people will feel more confident in their ability to cope with their pain with your support and confidence. Your role is to provide positive encouragement that they can cope with and manage their pain.
- Support – Pain may affect your child/teenager’s ability to complete homework, coursework, and revision. Offering support with studies may relieve some of the stress, in turn decreasing the chance of reoccurring pains. You may like to provide this information sheet to their school/college so they can provide extra support where necessary.
Apps:
Mindfulness and Sleep https:/
Meditation and Sleep https:/
Meditation: https://
Other pain resources:
The Pain Toolkit. This source lists a collection of useful resources for healthcare professionals, families of, and people living in pain: https://
The Retrain Pain Foundation has a good selection of short videos that are helpful in understanding pain: https:/
Painbytes also has a selection of videos that are helpful in learning to manage pain: http://
Other useful websites:
Resources for Teachers, Parents, Carers, and Children: http:/
Free Online Counselling: https:/
Mindful Breathing: www.
Mindful Activity: www.
Relaxation Techniques: www.
Relaxing Imagery: www.
Supporting Sleep: www.
Contact us
If you have any queries relating to this information, please contact the Paediatrics service.
About this information
Service:
Paediatrics
Reference:
P/103
Approval date:
1 July 2025
Review date:
1 July 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.