Cognitive Mediators of Treatment Outcomes in Pediatric Functional Abdominal Pain

Abstract

Objectives Cognitive-behavioral interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to one week post-treatment mediate improvement in outcomes in a randomized controlled trial of a brief cognitive-behavioral intervention for idiopathic childhood abdominal pain. Methods Two-hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions: a 3-session social learning and cognitive-behavioral treatment (SLCBT) (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3, 6 and 12 month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children. Results Multiple mediation analyses were applied to examine the extent to which the effects of the SLCBT condition on child GI symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents’ solicitous responses to their child’s pain symptoms. Reductions in parents’ perceived threat regarding their child’s pain mediated reductions in both parent- and child-reported GI symptom severity and pain. Reductions in children’s catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes. Discussion Results suggest that reductions in reports of children’s pain and GI symptoms following a social learning and cognitive-behavioral intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.

Pain catastrophizing in children with chronic pain and their parents: Proposed clinical reference points and reexamination of the Pain Catastrophizing Scale measure

“…al. [17] found child catastrophizing to be a mediator of reductions in child-reported gastrointestinal symptom severity, but not other outcomes; thus more research is needed to understand how pain catastrophizing may differentially impact outcomes. Future research should also establish clinical reference points for the PSC-P based on parent- specific measures of behavior and emotional functioning.…”

Pediatric Pain Beliefs Questionnaire: Psychometric Properties of the Short Form

“…This finding suggests that the treatment achieved the aims of reducing perceived pain threat and increasing pain efficacy beliefs. Reductions in parental pain threat appraisals during the intervention mediated reductions in child-reported GI symptom severity and child-reported pain at three, six, and twelve months 23 . Similar studies will need to be replicated with the PBQ-SF in order to provide further information regarding the treatment sensitivity and long-term predictive validity of the PBQ-SF subscales.…”

“…The original Pain Threat, PFCE, and EFCE subscales have been published with reliability data in several papers and tested in models which provide evidence for construct validity 27, 39, 45 , but never presented in a validation study. The PBQ has been utilized by several investigators 21, 23-28, 33, 34, 38, 45 in studies with a variety of designs (i.e., cross-sectional, longitudinal, and randomized controlled trials). The present study aims to: (1) create a short form of the PBQ (PBQ-SF) and (2) evaluate the internal consistency, test-retest reliability, concurrent validity, and construct validity of the subscales of the PBQ-SF in a large database of pediatric patients with FAP.…”

Maintenance of Pain in Children With Functional Abdominal Pain

“…Further, investigations of children who develop chronic pain and disability suggest that their parents are threatened by their children’s pain and inflexible in their acceptance and management of it. 35–37 Helping families recognize the potential for a longer term course of pain that both their child and they will need to manage may induce the families of these young children to learn effective techniques to manage the child’s pain and disability. That said, if children with abdominal pain are vulnerable to the development of anxiety as has been suggested, 25 such techniques can generalize to preventing and addressing anxiety symptoms as well.…”