Do Children With Functional Abdominal Pain Benefit More From a Pain-Specific Cognitive-Behavioral Intervention Than From an Unspecific Attention Control Intervention? Results of a Randomized Controlled Trial

Abstract

INTRODUCTION: We aimed to compare the efficacy of cognitive-behavioral therapy (CBT) among children with functional abdominal pain with an attention control (AC), hypothesizing the superiority of CBT group intervention regarding pain intensity (primary outcome), pain duration and frequency (further primary outcomes), functional disability, and quality of life and coping strategies (key secondary outcomes). METHODS: We conducted a prospective, multicenter, randomized controlled efficacy trial (RCT) with 4 time points (before intervention, after intervention, 3-month follow-up, and 12-month follow-up). One hundred twenty-seven children aged 7–12 years were randomized to either the CBT (n = 63; 55.6% girls) or the AC (n = 64; 57.8% girls). RESULTS: Primary endpoint analysis of the logarithmized area under the pain intensity curve showed no significant difference between groups (mean reduction = 49.04%, 95% confidence interval [CI] −19.98%–78.36%). Treatment success rates were comparable (adjusted odds ratio = 0.53, 95% CI 0.21–1.34, number needed to treat = 16). However, time trend analyses over the course of 1 year revealed a significantly greater reduction in pain intensity (40.9%, 95% CI 2.7%–64.1%) and pain duration (43.6%, 95% CI 6.2%–66.1%) in the CBT compared with the AC, but not in pain frequency per day (1.2, 95% CI −2.7 to 5.2). In the long term, children in the CBT benefitted slightly more than those in the AC with respect to functional disability, quality of life, and coping strategies. DISCUSSION: Both interventions were effective, which underlines the role of time and attention for treatment efficacy. However, in the longer term, CBT yielded more favorable results.

Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children

“…Sixty-seven records of 33 RCTs were included in the review. The included studies had a total sample of 2622 children with an age range of 4 to 18 years (median [range] age, 12 [7-17] years; 838 boys [32.7%]; 1726 girls [67.3%]).…”

“…Twelve studies compared CBT with no intervention, 5 studies compared CBT with educational support, 3 studies compared yoga with no intervention, 2 studies compared hypnotherapy with no intervention, 2 studies compared gut-directed hypnotherapy with hypnotherapy, and 2 studies compared guided imagery with relaxation.…”

“…Randomization was properly explained and rated as low risk of bias in 27 of 33 studies (81.8%), whereas 6 studies (18.2%) were rated as unclear for not providing enough information. Allocation concealment was rated as high risk of bias for 3 studies, unclear for 12 studies, and low for 18 studies that provided sufficient information on concealment.…”

“…All but 1 study, which used a sham control, were rated as high risk of bias for blinding participants and personnel blinding. Blinding the assessors was achieved by 13 of the studies, which were rated as low risk of bias in this domain, whereas 12 studies were rated as unclear and 8 studies as high risk.…”

Neuroimaging Mechanism of Cognitive Behavioral Therapy in Pain Management

“…In recent 2 years, a large number of clinical studies had taken CBT as a management measure of different kinds of pain, including mixed unlocated chronic pain [ 7 – 18 ], back pain [ 19 , 20 ], low back pain [ 21 – 26 ], chronic pancreatitis [ 27 ], fibromyalgia [ 28 , 29 ], functional abdominal pain [ 30 ], trigeminal neuralgia [ 31 ], haemophilia pain [ 32 ], osteoarthritis pain [ 33 – 35 ], perioperative pain [ 36 – 39 ], orofacial pain [ 40 ], diabetic peripheral neuropathic pain [ 41 ], and provoked vestibulodynia [ 42 ]. Previous studies on structural changes in the brain of patients with chronic pain indicated the presence of neuroplasticity in areas associated with the experience and anticipation of pain [ 43 ].…”