Cognitive-behavioral treatment of recurrent nonspecific abdominal pain in children: An analysis of generalization, maintenance, and side effects.

Abstract

From 10% to 15% of school-aged children experience recurring abdominal pain. This study evaluated the efficacy of a cognitive-behavioral program for the treatment of nonspecific recurrent abdominal pain (RAP) using a controlled group design. The multicomponent treatment program consisted of differential reinforcement of well behavior, cognitive coping skills training, and various generalization enhancement procedures. Multiple measures of pain intensity and pain behavior were conducted, including children's self-monitoring, parent observation, teacher observation, and observation by independent observers. Results showed that both the experimental and the control groups reduced their levels of pain. However, the treated group improved more quickly, the effects generalized to the school setting, and a larger proportion of subjects were completely pain-free by 3-months follow-up (87.5% vs. 37.5%). There was no evidence for any negative side effects of treatment.

The treatment of recurrent abdominal pain in children: A controlled comparison of cognitive-behavioral family intervention and standard pediatric care.

“…Pain intensity: A pain diary that measured the intensity of pain with a visual analogue scale (VAS) was used (see Sanders et al, 1989). The 10-cm visual analogue, in the shape of a thermometer, represented a continuum from no pain at all to very bad pain.…”

“…We used this methodology because previous research using independent observation in the home had been unsuccessful in sampling the caregiver interactions hypothesized to be central in the maintenance of pain. Such research had been unsuccessful because the pain behaviors in question are of relatively low frequency and are reactive to the presence of observers (Sanders et al, 1989).…”

“…Although case studies have shown that modifying the social consequences of pain behavior can be effective in treating RAP symptoms (e.g., Miller & Kratochwill, 1979;Sank & Biglan, 1974), only one group comparison study has evaluated cognitive-behavioral therapy for RAP (Sanders et al, 1989). This study evaluated an eight-session program that involved training children to use self-management skills (namely, relaxation, distraction, positive imagery, and coping selfstatements) and training their parents to prompt and reinforce children's use of these skills.…”

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

“…[10][11][12] The protocol had 1 standard and 3 optional modules that the therapist could select depending on the needs and problems of the child (see Table 1), allowing tailoring of the protocol to the individual child. This approach reflects normal practice and is suggested to be more effective than applying a standard protocol to every patient.…”

“…6,7 The effectiveness of psychological therapies for pediatric FAP has been studied in several randomized controlled trials (RCTs). [8][9][10][11][12][13] Although a recent Cochrane review described cognitive behavior therapy (CBT) as a promising psychological treatment, this review also underscored that many RCTs have considerable methodological drawbacks such as small sample sizes and high dropout rates. 14 Moreover, a well-designed RCT published after the Cochrane review did not provide unequivocal evidence for the benefit of CBT because it showed CBT to be superior to a control condition but only according to parent report of the child' s pain, not according to child-reported pain.…”