Restoration of Vagal Tone: A Possible Mechanism for Functional Abdominal Pain

Abstract

Functional abdominal pain (FAP) causes disruption of daily activities/missed school days, over utilization of healthcare, unnecessary surgeries, and anxiety in 10-15% of children. Its etiology is not clearly understood, however the success of several clinical protocols suggests that autonomic dysregulation is a factor. In this study autonomic activity, including heart rate variability (HRV), was compared between children with FAP and a comparison group. Twenty children with FAP and 10 children without FAP between the ages of 5 and 17 years old were compared on autonomic regulation using an ambulatory system at baseline and 8 weeks later. Children with FAP participated in 6 sessions of HRV biofeedback aimed at normalizing autonomic balance. At baseline, children with FAP appear to have more autonomic dysregulation than children without FAP. After completing HRV biofeedback, the FAP group was able to significantly reduce their symptoms in relation to significantly increasing their autonomic balance. In a sample of children with FAP, it appears that HRV biofeedback treatment improved their symptoms and that a change in vagal tone was a potential mediator for this improvement. The present study appears to point to excessive vagal withdrawal as an underlying mechanism of FAP.

Autonomic Testing in Women with Chronic Pelvic Pain

“…For example, increasing vagal tone through biofeedback decreases functional abdominal pain symptoms in children 25 . Heart rate variability analysis in our patient sample confirms the presence of reduced cardiac vagal tone in all CPP groups, greatest in the IC/BPS group.…”

Heart rate variability biofeedback: Theoretical basis, delivery, and its potential for the treatment of substance use disorders

“…A growing number of studies shows HRV BFB's potential for treating a variety of physical and mental disorders, including depression (Karavidas et al, 2007; Siepmann et al, 2008; Zucker et al, 2009), post-traumatic stress disorder (Tan, Dao, Farmer, Sutherland, & Gevirtz, 2011; Zucker et al, 2009), various anxiety disorders and stress symptoms (Henriques, Keffer, Abrahamson, & Horst, 2011; McCraty, Atkinson, Lipsenthal, & Arguelles, 2009; Nolan et al, 2005; Zucker et al, 2009), food craving (Meule, Freund, Skirde, Vögele, & Kübler, 2012), hypertension (Lin et al, 2012; McCraty et al, 2009; Nolan et al, 2005), chronic pain (Hallman, Olsson, von Schéele, Melin, & Lyskov, 2011; Hassett et al, 2007; Sowder, Gevirtz, Shapiro, & Ebert, 2010), asthma (Lehrer, Smetankin, & Potapova, 2000; Lehrer et al, 2004) and heart disease (Nolan et al, 2005). HRV BFB has also been shown to reduce symptom severity and improve quality of life for individuals with chronic obstructive pulmonary disease (Giardino, Chan, & Borson, 2004), and heart failure (Moravec, 2008), as well as for individuals reporting medically unexplained symptoms (Katsamanis et al, 2011).…”

Mind–Body Interventions for Pediatric Inflammatory Bowel Disease

“…However, research has shown that a person can, in fact, control this part of the nervous system when provided with appropriate feedback of its functioning [70]. In pediatric gastroenterology, mind–body research suggests that biofeedback may be helpful in treating symptoms of IBS and functional abdominal pain (FAP) such as dyspepsia, bloating, and cramping [71,72]. …”

“…A study by Sowder et al [72] investigated the effect of HRVB in children with FAP. Children participated in six sessions of HRVB aimed at normalizing autonomic balance.…”