Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study

Hotopf, Matthew; Carr, Siobhán; Mayou, Richard; Wadsworth, Michael; Wessely, Simon

doi:10.1136/bmj.316.7139.1196

Cited by 283 publications

(212 citation statements)

References 21 publications

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“…Frequent AP is associated with substantial disabilities in quality of life and daily functioning [59], particularly in attending school [29,38]. A part of children with AP is at risk of symptom persistence till adulthood [5,21,24,53]. Children with AP are found to score higher in questionnaires assessing psychopathological symptoms especially internalizing disturbances such as anxiety and other somatic complaints [14,17,52].…”

Section: Introductionmentioning

confidence: 96%

Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial

et al. 2013

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Functional abdominal pain and irritable bowel syndrome are two prevalent disorders in childhood which are associated with recurrent or chronic abdominal pain, disabilities in daily functioning, and reduced quality of life. This study aimed to evaluate a brief hypnotherapeuticbehavioral intervention program in a prospective randomized controlled design. Thirty-eight children, 6 to 12 years of age, and their parents were randomly assigned to a standardized hypnotherapeutic-behavioral treatment (n=20) or to a waiting list condition (n=18). Both groups were reassessed 3 months after beginning. Primary outcome variables were child-completed pain measures and pain-related disability. Secondary outcome variables were parent-completed measures of their children's pain and pain-related disability. Health-related quality of life from both perspectives also served as a secondary outcome. In the treatment group, 11 of 20 children (55.0 %) showed clinical remission (>80 % improvement), whereas only one child (5.6 %) in the waiting list condition was classified as responder. Children in the treatment group reported a significantly greater reduction of pain scores and pain-related disability than children of the waiting list condition. Parental ratings also showed a greater reduction of children's abdominal pain and pain-related disability. Health-related quality of life did not increase significantly. Conclusions: Hypnotherapeutic and behavioral interventions are effective in treating children with long-standing AP. Treatment success of this brief program should be further evaluated against active interventions with a longer follow-up.

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Section: Introductionmentioning

confidence: 96%

Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial

et al. 2013

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“…Further, there is evidence from large birth cohort studies to suggest that children with various pain syndromes, in particular abdominal pain and headache, experience an increased risk of abdominal pain, headache, musculoskeletal pain, and a variety of adverse psychological outcomes in later life (22)(23)(24)(25). In adults, recent studies have highlighted the importance of psychological factors, physical/mechanical factors, and a number of episode-specific characteristics such as the duration of symptoms, radiating sciatic pain, and physical limitation (26 -28).…”

Section: Introductionmentioning

confidence: 99%

Predicting persistent low back pain in schoolchildren: A prospective cohort study

Jones¹,

Macfarlane²

2009

Arthritis & Rheumatism

103

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Objective. Low back pain (LBP) is common in children but the prognostic indicators are poorly understood. We report the results of a prospective study to determine the risk factors for chronic LBP in children. Methods. A total of 330 children with LBP were identified from a cross-sectional survey in schools in Northwest England. Data were collected by self-completion questionnaire on a number of potential risk factors for LBP persistence, including lifestyle factors, the occurrence of other symptoms, behavioral and emotional characteristics, and symptom severity and duration. Participants were then followed over the following 4 years to determine persistent symptoms. Results. Complete followup data were available from 178 children, of whom 46 (26%) reported persistent LBP. Forward stepwise Poisson regression identified 5 independent predictors of pain persistence: peer relationship problems, being of smaller stature, the prior report of widespread body pain, long duration of LBP episodes, and radiating leg pain. Of children with none of these factors at baseline, <5% went on to report persistent LBP. In contrast, of those with 4 or 5 factors, nearly 80% experienced persistent symptoms. Conclusion. Although childhood consultations for LBP are infrequent, we have shown that ϳ25% of children 11-14 years of age with LBP still report symptoms 4 years later. These children can be identified early by a combination of clinical markers and etiologic factors. This provides a basis for considering interventions for secondary prevention; the challenge will be to determine whether we can intervene to alter symptom trajectory at an early stage.

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“…If left untreated, there is a considerable chance that FAP will persist into adulthood or change into other (psycho)pathology. 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.…”

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confidence: 99%

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

et al. 2013

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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.

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Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study

Cited by 283 publications

References 21 publications

Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial

Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial

Predicting persistent low back pain in schoolchildren: A prospective cohort study

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

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