6 - (IOP 35) Adults with Avoidant/restrictive Food Intake Disorder and Functional Dyspepsia Have Heightened Sensitivity to Mechanical Pain in the Abdomen

Sunday, November 23, 2025

11:15 AM - 11:30 AM CST

Location: Celestin H, Level 3

Keywords: Eating, Pain, Behavioral Medicine
Recommended Readings: Burton-Murray H, Ljótsson B, Healy B, Van Oudenhove L, Williams JS, Keefer L, Lawson EA,° Kuo B,° Thomas JJ.° Brief cognitive-behavioral treatment for avoidant/restrictive food intake disorder in the context of functional dyspepsia: Study protocol for a feasibility randomized controlled trial. Contemp Clin Trials. 2023 Nov; 134:107336., Burton Murray H, Jehangir A, Silvernale CJ, Kuo B, Parkman HP. Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis. Neurogastroenterol Motil. 2020 Dec; 32(12):e13931., Sieberg CB, Lunde CE, Shafrir AL, Meints SM, Madraswalla M, Huntley D, Olsen H, Wong C, DiVasta AD, Missmer SA, Sethna N. Quantitative somatosensory testing of the abdomen: establishing initial reference values across developmental age and biological sex. Pain. 2024 Jan 1;165(1):115-125. doi: 10.1097/j.pain.0000000000003001. Epub 2023 Jul 28. PMID: 37530649; PMCID: PMC10822023., ,

author(s)

Rebecca A. Karlson, B.S.

Clinical Research Coordinator
Center for Neurointestinal Health, Massachusetts General Hospital
Boston, MA, United States

Co-Author(s)

BP

Blythe Peterson, B.A.

Clinical Research Coordinator
Massachusetts General Hospital
Boston, MA, United States
AD

Abigail G. Dalton, B.S.

Clinical Research Coordinator
Eating Disorders Clinical and Research Program, Massachusetts General Hospital
Boston, MA, United States
MA

Micaela Atkins, M.D.

Physician
MassGeneral for Children's Gastroenterology & Nutrition, Pediatric
Boston, MA, United States
KS

Kyle Staller, M.P.H., M.D.

Physician
Massachusetts General Hospital
Boston, MA, United States
LS

Lauren Shabazian, Other

Clinical Research Nurse Practitioner
Neuroendocrine and Gastroenterology Units Massachusetts General Hospital
Boston, MA, United States
LV

Lukas Van Oudenhove, M.D., Ph.D.

Research Professor
Translational Research Center for Gastrointestinal Disorders, University of Leuven
Leuven, Vlaams-Brabant, Belgium
LK

Laurie Keefer, Ph.D.

Academic Health Psychologist
Icahn School of Medicine at Mount Sinai
New York, NY, United States
RS

Roberta Sclocco, Ph.D.

Assistant Professor
Department of Medicine Massachusetts General Hospital and Harvard Medical School
Boston, MA, United States
Kendra R. Becker, Ph.D.

Clinical Psychologist
Mass General Psychiatry: Eating Disorders Clinical and Research Program
Boston, MA, United States
EL

Elizabeth A. Lawson, M.D.

Associate Professor of Medicine
Massachusetts General Hospital/Harvard Medical School
Boston, MA, United States
JT

Jennifer J. Thomas, Ph.D.

Clinical Psychologist
Mass General Psychiatry: Eating Disorders Clinical and Research Program
Boston, MA, United States
BK

Braden Kuo, M.D.

Physician
Mass General Gastroenterology
Boston, MA, United States
SM

Samantha M. Meints, Ph.D.

Assistant Professor
Brigham and Women’s Hospital / Harvard Medical School
Chestnut Hill, MA, United States
RE

Robert Edwards, Ph.D.

Associate Professor
Brigham and Women’s Hospital / Harvard Medical School
Boston, MA, United States
Helen Burton-Murray, Ph.D.

Clinical Psychologist
Department of Psychiatry at Mass General
Boston, MA, United States

Introduction: Functional dyspepsia (FD) is a chronic gastrointestinal (GI) pain disorder with no known underlying cause, characterized by upper abdominal pain, early satiation, and postprandial discomfort. A subset of adults with FD attempt to modulate pain with maladaptive behaviors such as problematic food avoidance/restriction, with up to 40% screening positive for avoidant/restrictive food intake disorder (ARFID). Dysregulation in pain processing may be a risk and/or maintenance factor for ARFID in the context of FD. We aimed to test if aspects of pain processing are different in those with FD+ARFID compared to FD (no ARFID) and healthy controls (HC).

Methods: Subjects included adults from an ongoing study with FD (n=13), FD+ARFID (n=33), and HC (n=18). Overall demographics: Age – M=36, SD=13.3 years; Race – 16% Asian, 11% Black/African American, 78% White; Ethnicity – 16% Hispanic/Latino/a/x; Gender identity – 75% female, 22% male, 2% other, 1% prefer not to say; Sex – 78% female; limited English proficiency – 6%. We administered a Quantitative Sensory Test (QST) battery (in English or Spanish) to characterize pain processing to noxious stimuli applied to non-abdominal and abdominal areas. We measured pain sensitivity by digital pressure algometer depressed at a constant rate at two sites (bi-lateral trapezius, center of each abdominal quadrant) — pain threshold (pressure level when subject reports first experience of pain) and tolerance (pressure level when subject reports intolerable pain). We measured central sensitization by temporal summation where subjects reported pain on a 0 (“no pain”) to 100 (“worst pain imaginable”) scale from the first to tenth application of a sharp sensation (NeuroPen) at two sites (middle finger of non-dominant hand, center of each abdominal quadrant). For abdominal QST, we created an average score across quadrants. We corrected for two tests per QST parameter: p<.025.

Results: There were no significant differences in trapezius pressure thresholds or tolerance levels among groups (η²=.011-.032, p=.14-.26). Abdominal pain pressure threshold was significantly different among groups with medium effect (η²=.090, p=.024) — significantly lower pain thresholds in FD+ARFID vs HC with medium effect (r=.34, p=.0031), but only small, non-significant differences for FD vs HC (r=.17, p=.091) and FD+ARFID vs FD (r=.12, p=.17). Abdominal pain pressure tolerance was significantly different among groups with medium-large effect (η²=.10, p=.019) — both FD+ARFID and FD had significantly lower pain thresholds compared to HC with small-medium effects (r=.22-.35, p=.0027-.042), but a small, non-significant difference for FD+ARFID vs FD (r=.071, p=.28). Groups did not significantly differ in central sensitization (by temporal summation).

Conclusions: Adults with FD have heightened sensitivity to abdominal pain, evidenced by lower pain thresholds and tolerance by QST compared to healthy adults. Comorbid ARFID in FD may be associated with greater abdominal pain sensitivity, which could indicate a biomarker amenable to prevention/intervention efforts. However, further research is needed with larger samples and expanded QST batteries, including concordance with measure of gastric visceral sensitivity.

Learning Objectives:

At the end of this session, the learner will be able to:

Describe pain processing (by quantitative sensory testing) in adults with ARFID in the setting of a gastrointestinal pain disorder (functional dyspepsia).