Conceptualization and Treatment of Chronic Abdominal Pain in Pediatric Gastroenterology Practice

Schurman, Jennifer Verrill; Hunter, Heather L.; Friesen, Craig A.

doi:10.1097/mpg.0b013e3181ae3610

Cited by 63 publications

(72 citation statements)

References 9 publications

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“…A recent study showed that only a small percentage of pediatric gastroenterologists (14%) recommended lifestyle changes in patients with FGIDs. 27 Even though patients in our study were seen at a tertiary care center, none of the obese patients had documented counseling on dietary and lifestyle modifications during their visits. As we learn more about the relationship between these two prevalent conditions in childhood, it seems reasonable to intervene as early as possible to potentially prevent the development of functional abdominal pain, and if not possible to improve the response to standard medical treatment precluding abdominal pain from becoming a chronic condition.…”

Section: Discussionmentioning

confidence: 99%

Obesity predicts persistence of pain in children with functional gastrointestinal disorders

Bonilla

Saps

2010

Int J Obes

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Objective: The possible effect of obesity in the outcome of treated children with abdominal pain-related functional gastrointestinal disorders (FGIDs) has not yet been studied. We hypothesized that obesity is associated with a poor long-term prognosis in children with FGIDs. Study design: Prospective cohort study in an outpatient clinic-based sample of patients diagnosed with abdominal pain-related FGIDs. Principal outcome measured was persistence of pain at long-term follow-up (12-15 months). Frequency of pain, intensity of pain, school absenteeism and disruption of daily activities were compared between obese and non-obese subjects. Results: The group mean age was 13.27 ± 3.84 years, distribution of diagnosis was 32% (functional abdominal pain), 42.5% (irritable bowel syndrome) and 25.5% (functional dyspepsia). Overall, 20.2% of patients were obese. A total of 116 patients (61.7%) reported abdominal pain and 72 (38.3%) were asymptomatic at long-term follow-up. Obese patients were more likely to have abdominal pain (Po0.0001), higher intensity of pain (P ¼ 0.0002), higher frequency of pain (P ¼ 0.0032), school absenteeism (Po0.0001) and disruption of daily activities (Po0.0001) at follow-up than non-obese patients. Conclusion: Obesity is associated with poor outcome and disability at long-term follow-up in children with abdominal pain-related FGIDs. Our novel findings could have important implications in the prognosis and management of FGIDs.

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Section: Discussionmentioning

confidence: 99%

Obesity predicts persistence of pain in children with functional gastrointestinal disorders

Bonilla

Saps

2010

Int J Obes

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“…Commonly, physicians treating CAP work to ensure that there are no red flags for diagnosis of an organic disease and provide reassurance that the condition is nothing to worry about, brief education on the biopsychosocial model for chronic abdominal pain, and referral out for cognitive-behavioral therapy, hypnotherapy, or another treatment aimed at stress reduction and return to function [27]. For some caregivers, this approach may seem inadequate to address their concerns about their child's symptoms.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Acceptability of a Personalized Assessment of Chronic Abdominal Pain Triggers

Cushing¹,

Kichline²,

Blossom³

et al. 2017

Preprint

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Background: Though there is general consensus that pediatric chronic abdominal pain is likely the result of interacting biopsychosocial pathways, studies produce mixed evidence for its etiology. These mixed results could be due to the nonstationarity of the effects over time or because there are individual differences uncaptured by current research designs. In either case, intensive longitudinal data collected from the biopsychosocial systems that dynamically influence chronic abdominal pain should add clarity. Objective: The current study aimed to determine if it was feasible and acceptable to use ecological momentary assessment (EMA) to assess biopsychosocial contributors to chronic abdominal pain with two objective sensors and a mobile application. In addition, we aimed to determine if it was possible to identify idiographic pain triggers for each patient. Method: Participants included 30 pediatric chronic abdominal pain patients, aged 8-17, who wore a physiological monitor and accelerometer that measured sleep and physical activity and answered four surveys per day on an app over the course of a 14-day study period. Results: Results indicated that participants were 96.2% and 95.5% compliant to the wrist-worn accelerometer measuring sleep and physical activity, respectively. Participants completed 76.3% of expected surveys and were least adherent to the physiological monitor (37.9%). Additionally, it was possible to generate 24 (80%) personalized reports describing unique pain triggers for participants in the study. Conclusion: Findings support the use of EMA and longitudinal assessment to examine real-time interactions between biopsychosocial variables in this population.2

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“…When surveyed, approximately 65% of paediatric gastroenterologists reported routinely referring to a mental health practitioner when no 'organic' cause of abdominal pain is identified [1]. However, studies indicate that only 40-60% of paediatric patients referred for mental health services by a physician follow through with this referral [5,6].…”

Section: International Journal Of Integrated Care -Vol 10 2 August mentioning

confidence: 99%

“…However, this approach has not been wholly satisfactory. In a recent survey, approximately 60% of paediatric gastroenterologists report a successful outcome in less than half of their patients [1]. One difficulty with the traditional medical…”

Section: Introductionmentioning

confidence: 99%

Integrative treatment approaches: family satisfaction with a multidisciplinary paediatric Abdominal Pain Clinic

Schurman¹,

Friesen²

2010

Int J Integr Care

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Objectives: To assess patient and family satisfaction with evaluation received through a multidisciplinary paediatric Abdominal Pain Clinic (APC) staffed by a paediatric gastroenterologist and a paediatric psychologist as compared to a traditional gastroenterology clinic (GI) staffed by a paediatric gastroenterologist only. Methods:Two hundred and ninety-eight families (145 APC, 153 GI) with a child or adolescent aged 8-17 years seen for initial evaluation of a chronic abdominal pain completed an anonymous survey to assess understanding of the treatment recommendations made, intent to follow through with various treatment recommendations, and the overall level of satisfaction with the evaluation service provided. Family perceptions of strengths and challenges of the APC evaluation process also were explored.Results: APC families reported being prescribed adjunctive mental health and other therapies at significantly higher rates than GI families, while the rates of medication were comparable. APC families also reported significantly greater receptivity to beginning the treatments prescribed and higher levels of overall satisfaction with the evaluation process. The contribution of integrated medical and psychological perspectives frequently was identified as a strength of the APC evaluation process. Challenges identified for the APC evaluation were few and focused on issues related to paperwork and scheduling issues. Conclusions:Integrative care approaches to the evaluation of paediatric abdominal pain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations. Integrative care starting at the time of first evaluation may be particularly well-tailored to enhance outcomes, reduce health care utilization, and yield financial savings within this population.

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Conceptualization and Treatment of Chronic Abdominal Pain in Pediatric Gastroenterology Practice

Cited by 63 publications

References 9 publications

Obesity predicts persistence of pain in children with functional gastrointestinal disorders

Obesity predicts persistence of pain in children with functional gastrointestinal disorders

Feasibility and Acceptability of a Personalized Assessment of Chronic Abdominal Pain Triggers

Integrative treatment approaches: family satisfaction with a multidisciplinary paediatric Abdominal Pain Clinic

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