Treatment of Nonorganic Recurrent Abdominal Pain

Duarte, Marco Antônio Húngaro; Penna, Francisco José; Andrade, Eugênio Marcos Goulart; Cancela, Camila Silva Peres; Neto, Joaquim Caetano Aguirre; Barbosa, Terezinha Facury

doi:10.1097/01.mpg.0000226373.10871.76

Cited by 88 publications

(54 citation statements)

References 46 publications

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“…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%

“…36,[44][45][46]48,49 Due to the nature of HT, CBT, WSD, and yoga, blinding was not possible for the caregiver or patient. 25,28,29,31,32,[44][45][46][47][48][49][50] Dropout was considerable in 4 studies 36,40,41,47 or vaguely described in 3 others. 31,46,50 Two studies excluded patients due to poor compliance.…”

Section: Methodologic Qualitymentioning

confidence: 99%

“…Two systematic reviews 12 45 reported significantly decreased abdominal pain frequency at 3 months' followup (P = .001), but no effect was seen for pain intensity. In the study by Robins et al, 47 CBT-family added to standard care resulted in a significantly lower abdominal pain index compared with standard care alone (P , .05), with continuing effects at 6 and 12 months of follow-up.…”

Section: Cognitive Behavioral Therapymentioning

confidence: 99%

“…70 Trials in children and adolescents also indicate beneficial effects of CBT, especially CBT-family, in improving pain and disability, and the effects seem to be long-lasting. 26,28,31,[45][46][47] Results of the trial by Levy et al are of particular interest because it included 200 children and adolescents. 31 An RCT on individual CBT published shortly after the literature search for the present systematic review showed improvement in 60% of children with FAP after CBT, but the results did not differ compared with standard care (including 6 supportive sessions with the pediatric gastroenterologist).…”

Section: Alternative Medicinementioning

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%

Section: Methodologic Qualitymentioning

confidence: 99%

Section: Cognitive Behavioral Therapymentioning

confidence: 99%

Section: Alternative Medicinementioning

confidence: 99%

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Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

et al. 2015

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“…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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Twelve-Month Follow-up of Cognitive Behavioral Therapy for Children With Functional Abdominal Pain

et al. 2013

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Treatment of Nonorganic Recurrent Abdominal Pain

Abstract: The cognitive-behavioral family intervention reduced the frequency of pain crises of children with nonorganic RAP. This successful intervention was carried out by the intervention of general pediatricians.

Cited by 88 publications

References 46 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

Twelve-Month Follow-up of Cognitive Behavioral Therapy for Children With Functional Abdominal Pain

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