Recurrent Abdominal Pain in Children: Summary Evidence From 3 Systematic Reviews of Treatment Effectiveness (original) (raw)
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Psychosocial interventions for recurrent abdominal pain in childhood
The Cochrane library, 2017
Background This review supersedes the original Cochrane review first published in 2008 (Huertas-Ceballos 2008). Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. No organic cause for this pain can be found on physical examination or investigation for the majority of such children. Although many children are managed by reassurance and simple measures, a large range of psychosocial interventions involving cognitive and behavioural components have been recommended. Objectives To determine the e ectiveness of psychosocial interventions for reducing pain in school-aged children with RAP. Search methods In June 2016 we searched CENTRAL, MEDLINE, Embase, eight other databases, and two trials registers. We also searched the references of identified studies and relevant reviews. Selection criteria Randomised controlled trials comparing psychosocial therapies with usual care, active control, or wait-list control for children and adolescents (aged 5 to 18 years) with RAP or an abdominal pain-related functional gastrointestinal disorder defined by the Rome III criteria were eligible for inclusion. Data collection and analysis We used standard methodological procedures expected by Cochrane. Five review authors independently selected studies, assessed them for risk of bias, and extracted relevant data. We also assessed the quality of the evidence using the GRADE approach. Main results This review includes 18 randomised controlled trials (14 new to this version), reported in 26 papers, involving 928 children and adolescents with RAP between the ages of 6 and 18 years. The interventions were classified into four types of psychosocial therapy: cognitive behavioural therapy (CBT), hypnotherapy (including guided imagery), yoga, and written self-disclosure. The studies were carried out in the USA, Australia, Canada, the Netherlands, Germany, and Brazil. The majority of the studies were small and short term; only two studies included more than 100 participants, and only five studies had follow-up assessments beyond six months. Small sample sizes and the Psychosocial interventions for recurrent abdominal pain in childhood (Review)
Methodological Challenges to Treatment Trials for Recurrent Abdominal Pain in Children
Archives of Pediatrics & Adolescent Medicine, 2003
Background: Studies evaluating the efficacy of treatments for recurrent abdominal pain (RAP) in children have used a wide range of methods, causing difficulty in the comparison of results. An expert panel on functional gastrointestinal disorders recently made recommendations regarding the standardization of study methods for childhood RAP, but many of their recommendations remain untested or lack supportive evidence. Methods: During completion of a pilot study and randomized controlled trial for childhood RAP, baseline data were collected regarding the child and parent reports of abdominal pain frequency and intensity, type of abdominal pain, missed activities due to abdominal pain, psychological factors for the parent and child, parenting styles, and referral source (pediatric gastroenterologist vs general pediatrician). Results: Children and parent pain reports showed good agreement in children younger than 13 years (weighted , 0.77; 95% confidence interval [CI], 0.71-0.84), but only marginal agreement in children 13 years or older (weighted , 0.37; 95% CI, 0.30-0.45). We found no significant differences in pain characteristics or psychological factors between children referred by pediatric gastroenterologists in a tertiary care center and those referred by communitybased primary care pediatricians. However, children with symptoms consistent with nonspecific functional abdominal pain were reported by their parents to have less frequent pain (P=.003) and fewer missed activities (P=.003) than children with symptoms of irritable bowel syndrome or functional dyspepsia. Conclusions: Subjects referred by gastroenterologists and general pediatricians were similar, but the subtype of functional gastrointestinal disorder might be an important baseline characteristic of subjects in future RAP studies. We suggest that future interventional studies of childhood RAP measure 2 outcomes with pain reports obtained directly from children. Any child with fewer days of pain and missed activities due to pain after therapy would be considered improved, and those with no missed activities and 4 or fewer days of pain per month at follow-up would be considered healed.
Dietary interventions for recurrent abdominal pain in childhood
The Cochrane library, 2017
Analysis 1.1. Comparison 1 Probiotics versus placebo, Outcome 1 Change in pain frequency: 0 to 3 months' postintervention..... Analysis 1.2. Comparison 1 Probiotics versus placebo, Outcome 2 Change in pain frequency: 0 to 3 months' postintervention.
The Management of Paediatric Functional Abdominal Pain Disorders: Latest Evidence
Pediatric Drugs, 2018
Recurrent abdominal pain (RAP) is one of the most common health complaints in both children and adults. Although RAP is considered a functional disorder rather than an organic disease, affected children and their families can still experience anxiety and concerns that can interfere with school, sports, and regular daily activities and lead to frequent attendances at pediatric emergency departments or pediatric gastroenterology clinics. Our review shows experts do not agree on a universally proven management that will work on every child presenting with functional abdominal pain (FAP). Treatment strategies include both non-pharmacological and pharmacological options. Non-pharmacological treatments are usually very well accepted by both children and their parents and are free from medication side effects. Nevertheless, they may be as effective as the pharmacological interventions; therefore, according to many experts and based on the majority of current evidence, a non-pharmacological approach should be the first intervention attempt in children with RAP. In particular, the importance of the biopsychosocial approach is highlighted, as a majority of children will improve with counselling and reassurance that no serious organic pathologies are suspected, especially when the physician establishes a trustful relationship with both the child and their family. Placebo and pharmacological interventions could be attempted when the bio-psychosocial approach is not applicable or not efficacious. In some difficult cases, finding an effective treatment for FAP can be a challenge, and a number of strategies may need to be tried before symptoms are controlled. In these cases, a multidisciplinary team, comprising a pediatric gastroenterologist, dietician, psychologist, and psychotherapist, is likely to be successful. Key Points Recurrent abdominal pain (RAP) is one of the most common health complaints in both children and adults. There is no agreement among experts on a universally proven management that will work on every child presenting with RAP. An effective treatment for functional abdominal pain can be a challenge, and a number of strategies may need to be tried before symptoms are controlled; in some cases, only a multidisciplinary approach is likely to be successful.
Evidence-Based Child Health: A Cochrane Review Journal, 2011
Background: Chronic abdominal pain is a common, disabling and longstanding condition for children and their families that often involves lengthy treatment plans and regular re-evaluation. Chronic abdominal pain refers to both organic and functional pain, although for the majority of children and adolescents, the pain is functional in origin. Clinicians often feel pressure from parents to provide some type of treatment, and a large number of interventions are used in an attempt to decrease associated symptoms and functional impairment. Substantial variation in the treatment of childhood chronic abdominal pain currently exists.
Consolidated Summary of Current Treatment Modalities of Childhood Functional Abdominal Pain
Functional gastrointestinal disorders (FGIDs) consists of range of disorders which cannot be explained by structural or biochemical abnormalities. Managing functional abdominal pain by traditional pharmacological therapies in children are failing to achieve the desired outcome, whereas new pharmacological and non-pharmacological approaches are showing promising results. The aim of this review is to provide the clinicians an overview and summary of recent literature of pharmacological and non-pharmacological options in management of functional abdominal pain in children and adolescent. This review article discusses about latest evidences which includes randomized controlled trials, retrospective studies, reviews, observational studies and evidence based medicine search on MEDLINE and Cochrane library. Non-pharmacological treatments are as effective as pharmacological treatments in children with functional abdominal pain (FAP) particularly bio-psychosocial modifying therapies and probiotic supplementation with Lactobacillus reuteri DSM 17938 which have shown beneficial actions. Due tosafety and tolerability guidelines, many experts believe that in management of FAP, non-pharmacological interventions should be the first line of treatment in children.
PEDIATRICS, 2005
Objective. Recurrent abdominal pain (RAP) is a common problem in children and adolescents. Evaluation and treatment of children with RAP continue to challenge physicians because of the lack of a psychometrically sound measure for RAP. A major obstacle to progress in research on RAP has been the lack of a biological marker for RAP and the lack of a reliable and valid clinical measure for RAP. The objectives of this study were (1) to develop and test a multidimensional measure for RAP (MM-RAP) in children to serve as a primary outcome measure for clinical trials, (2) to evaluate the reliability of the measure and compare its responses across different populations, and (3) to examine the reliabilities of the measure scales in relation to the demographic variables of the studied population.
Effects of psychological treatment on recurrent abdominal pain in children — A meta-analysis
Clinical Psychology Review, 2011
Recurrent abdominal pain in children has a high prevalence, thought to be about 10%. Untreated, there is a high risk that the symptoms become chronic and may lead in some cases to co-morbid mental disorders. Evidence-based treatments are therefore urgently needed. The objective of this study was to examine the effectiveness of psychological therapies for pain reduction in children with recurrent abdominal pain (RAP) by a meta-analysis of intervention studies. Ten controlled studies fulfilling minimum methodical criteria were included. The results of the analysis showed that psychological therapies, mainly cognitive-behavioural, have a moderate effect on the reduction of pain in children with RAP. After analysing homogeneity and significance with the fixed effect model, the medium effect size, calculated with Hedges g, was 0.58 (σ=0.16), demonstrating highly significant (p<.01) effects. The study showed that psychological therapies are effective in treating children with chronic abdominal pain. The empirical basis in this field needs to be broadened.
Journal of Pediatric Gastroenterology and Nutrition, 2005
Chronic abdominal pain, defined as longlasting intermittent or constant abdominal pain, is a common pediatric problem encountered by primary care physicians, medical subspecialists, and surgical specialists. Chronic abdominal pain in children is usually functional, that is, without objective evidence of an underlying organic disorder. The Subcommittee on Chronic Abdominal Pain of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition has prepared this report based on a comprehensive, systematic review and rating of the medical literature. This report accompanies a clinical report based on the literature review and expert opinion.