Brief telephone-delivered cognitive behavioral therapy targeted to parents of children with functional abdominal pain: a randomized controlled trial

Abstract

Pediatric functional abdominal pain disorders (FAPD) are associated with increased healthcare utilization, school absences, and poor quality of life (QoL). Cost-effective and accessible interventions are needed. This multi-site study tested the effects of a 3-session cognitive-behavioral intervention delivered to parents, in person or remotely, on the primary outcome of pain severity and secondary outcomes (process measures) of parental solicitousness, pain beliefs, catastrophizing, and child-reported coping. Additional outcomes hypothesized a priori and assessed included functional disability, quality of life, pain behavior, school absences, healthcare utilization, and gastrointestinal symptoms. The study was prospective and longitudinal (baseline, 3 and 6 months follow-up) with three randomized conditions: social learning and cognitive-behavioral therapy in-person (SLCBT) or by phone (SLCBT-R) and education/support condition by phone (ES-R). Participants were children aged 7–12 with FAPD and their parents (N = 316 dyads). While no significant treatment effect for pain severity was found, the SLCBT groups showed significantly greater improvements compared to controls on process measures of parental solicitousness, pain beliefs and catastrophizing, and additional outcomes of parent-reported functional disability, pain behaviors, child healthcare visits for abdominal pain, and (remote condition only) quality of life and missed school days. No effects were found for parent and child-reported gastrointestinal symptoms, or child-reported quality of life or coping. These findings suggest that for children with FAPD, a brief phone SLCBT for parents can be similarly effective as in-person SLCBT in changing parent responses and improving outcomes, if not reported pain and symptom report, compared to a control condition.

Chronic Pain in the School Setting: The Teachers' Point of View

“…Studies including parents of children who have chronic pain have found that discouraging and solicitous responses are related to negative outcomes, eg, children having higher levels of pain intensity and disability or depression and anxiety . On the other hand, coping responses have been found to be predictive of lower pain intensity and/or disability, as well as an array of somatic symptoms, depression or anxiety . In this study, experienced teachers reported responding to students with chronic pain using with solicitous responses more often than student teachers.…”

Low FODMAP diet in children and adolescents with functional bowel disorder: A clinical case note review

“…Given that 17% of children in this study experienced stress and anxiety, psychological strategies need to be used in concert with dietary interventions. Randomized and observational studies provide relatively compelling but limited evidence that psychological interventions are associated with improved pain tolerance, reduced anxiety, increased nonpain behavior, and improved self‐management . In a prospective study in which 322 children with functional abdominal pain were followed to young adulthood, the lifetime risk of anxiety and depression were 51 and 40%, respectively (compared 20 and 16%, respectively, in controls) .…”

The role of psychological factors in pediatric functional abdominal pain disorders

“…These behaviors are driven by threat appraisals or catastrophic thinking about pain and predict both disability and health outcomes. We have previously reported that by intervening only with parents, through reduction of pain threat, and changing parental behaviors, we can improve health outcomes in children with FAPD . Hence, parental behaviors and cognitions are important predictors and treatment targets for children with FAPD.…”