Cognitive Behavior Therapy for Pediatric Functional Abdominal Pain: A Randomized Controlled Trial

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Pediatric functional abdominal pain is common and costly. Cognitive behavior therapy (CBT) is a promising treatment for these complaints, but solid evidence for its effectiveness is lacking. WHAT THIS STUDY ADDS:This randomized controlled trial shows that CBT reduces abdominal pain in 60% of children 1 year after treatment. Six sessions of CBT delivered by trained master' s students in psychology were equally effective as 6 visits to an experienced pediatrician. abstract OBJECTIVE: This randomized controlled trial investigated the effectiveness of a 6-session protocolized cognitive behavior therapy (CBT) compared with 6 visits to a pediatrician (intensive medical care; IMC) for the treatment of pediatric functional abdominal pain (FAP). METHODS:One hundred four children aged 7 to 18 were randomized to CBT or IMC. CBT was delivered primarily by trained master' s degree students in psychology; IMC was delivered by pediatricians or pediatric gastroenterologists. Assessments were performed pretreatment, posttreatment, and at 6-and 12-month follow-up. Primary outcomes were level of abdominal pain (AP) as reported on questionnaires and diaries. Secondary outcomes were other gastrointestinal complaints, functional disability, other somatic complaints, anxiety, depression, and quality of life.RESULTS: Both CBT and IMC resulted in a significant decrease in AP (P , .001), but no significant difference was found between the treatments in their effectiveness (P . .05 for all end points). According to the questionnaire-derived data, 1 year after treatment, 60% of children that received CBT had significantly improved or recovered, versus 56.4% of children receiving IMC, which did not significantly differ (P = .47). These percentages were 65.8% versus 62.8% according to the diary-derived data, which also did not significantly differ (P = .14). Additionally, nearly all secondary outcomes improved after treatment.CONCLUSIONS: CBT was equally effective as IMC in reducing AP in children with FAP. More research into the specific working mechanisms of CBT for pediatric FAP is needed.

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

“…31 An RCT on individual CBT published shortly after the literature search for the present systematic review showed improvement in 60% of children with FAP after CBT, but the results did not differ compared with standard care (including 6 supportive sessions with the pediatric gastroenterologist). 71 However, children receiving CBT reported significantly fewer symptoms of anxiety or depression compared with children receiving standard care.…”

Pediatric inflammatory bowel disease and depression

“…(57) Similar CBT approaches have also been shown to improve pain and sleep disturbances in other pediatric populations. (58, 59) Additional promising psychosocial interventions for youth with IBD include hypnotherapy(60) and mindfulness-based techniques(61) which both can improve mood, pain and HRQoL.…”

Differential changes in functional disability and pain intensity over the course of psychological treatment for children with chronic pain

“…In practice, outpatient treatments for chronic pain emphasize a rehabilitative approach including decreasing pain-related disability, and it has been a common dictum among clinicians that “improvement is first measured by increased functioning” [38, p. 262]. In research including clinical trials, pain intensity typically has been identified as the primary treatment outcome; however, there is an increasing focus on demonstrating functional improvement as well as pain reduction [17,35] as recommended by leading pediatric pain experts [23]. However, there is a challenge to providers in the clinic setting to assure patients that increased function in the absence of pain reduction is a positive sign, and that functional progress should not wait on pain resolution.…”