Evaluation of a Cognitive–Behavioral Pain Management Program for Children with Chronic Abdominal Pain: A Randomized Controlled Study

Groß, Martina; Warschburger, Petra

doi:10.1007/s12529-012-9228-3

Cited by 63 publications

(78 citation statements)

References 29 publications

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“…Thirteen articles remained for analysis: 7 systematic reviews 11,12,15,16,18,22,23 (including 18 RCTs) and 6 RCTs. [24][25][26][27][28][29] Two included trials concerned follow-up studies, 26,30 which will be discussed by using their original studies. 31,32 Two systematic reviews 11,12 included studies with ,10 patients per treatment arm, and these studies were therefore excluded.…”

Section: Resultsmentioning

confidence: 99%

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Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

et al. 2015

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BACKGROUND AND OBJECTIVE: Various nonpharmacologic treatments are available for pediatric abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). Data on efficacy and safety are scarce. The goal of this study was to summarize the evidence regarding nonpharmacologic interventions for pediatric AP-FGIDs: lifestyle interventions, dietary interventions, behavioral interventions, prebiotics and probiotics, and alternative medicine.METHODS: Searches were conducted of the Medline and Cochrane Library databases. Systematic reviews and randomized controlled trials (RCTs) concerning nonpharmacologic therapies in children (aged 3-18 years) with AP-FGIDs were included, and data were extracted on participants, interventions, and outcomes. The quality of evidence was assessed by using the GRADE approach.RESULTS: Twenty-four RCTs were found that included 1390 children. Significant improvement of abdominal pain was reported after hypnotherapy compared with standard care/wait-list approaches and after cognitive behavioral therapy compared with a variety of control treatments/wait-list approaches. Written self-disclosure improved pain frequency at the 6-month follow-up only. Compared with placebo, Lactobacillus rhamnosus GG (LGG) and VSL#3 were associated with significantly more treatment responders (LGG relative risk: 1.31 [95% confidence interval: 1.08 to 1.59]; VSL#3: P , .05). Guar gum significantly improved irritable bowel syndrome symptom frequency; however, no effect was found for other fiber supplements (relative risk: 1.17 [95% confidence interval: 0.75 to 1.81]) or a lactose-free diet. Functional disability was not significantly decreased after yoga compared with a wait-list approach. No studies were found concerning lifestyle interventions; gluten-, histamine-, or carbonic acid-free diets; fluid intake; or prebiotics. No serious adverse effects were reported. The quality of evidence was found to be very low to moderate. CONCLUSIONS:Although high-quality studies are lacking, some evidence shows efficacy of hypnotherapy, cognitive behavioral therapy, and probiotics (LGG and VSL#3) in pediatric AP-FGIDs. Data on fiber supplements are inconclusive.

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Section: Resultsmentioning

confidence: 99%

“…25,32,44 Seven studies compared CBT with standard care, physiotherapy, fiber supplements, biofeedback, and/or parental support. 28,31,[45][46][47][48][49] One trial compared yoga with a wait-list, 50 and 1 trial evaluated written self-disclosure (WSD) in addition to standard care. 29 No studies were included on lifestyle advice or prebiotics.…”

Section: Resultsmentioning

confidence: 99%

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

et al. 2015

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“…On the basis of an earlier study, 13 we expected a 31.8% difference in effectiveness between CBT and IMC. To be able to detect that difference with an 80% power and a 2-sided 5% significance level, a sample size of 45 participants per group was necessary.…”

Section: Calculation Of Sample Sizementioning

confidence: 94%

“…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.…”

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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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“…A study in the United States was able to show that self-administered audio-recorded HT for children and adolescents with FAP (6-15 years) was superior to a waiting list condition [47]. The employment of standardized psychotherapeutic interventions in childhood FGIDs is not common in Germany [20,44]. Therefore, we conducted a brief intervention program based on hypnotherapeutic and behavioral methods.…”

Section: Introductionmentioning

confidence: 99%

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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Evaluation of a Cognitive–Behavioral Pain Management Program for Children with Chronic Abdominal Pain: A Randomized Controlled Study

Abstract: Cognitive-behavioral methods seem to be appropriate for treating children with CAP.

Cited by 63 publications

References 29 publications

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

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

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

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