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Treatment options for functional abdominal pain
Colin D Rudolph1, Adrian Miranda
1Medical College of Wisconsin, Children's Hospital of Wisconsin, USA.
Insights
Successful pediatric functional abdominal pain (FBD) treatment relies on early physician-family trust and clear communication. Addressing psychosocial factors and utilizing targeted therapies optimize diagnosis and care for children with FBD.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Functional Abdominal Pain Disorders
Background:
- Pediatric functional abdominal pain disorders (FBD) require a comprehensive approach.
- Establishing trust between physician and family is crucial for successful treatment.
- Early consideration of functional pain in differential diagnosis prevents unnecessary testing.
Purpose of the Study:
- To outline an effective strategy for diagnosing and treating pediatric FBD.
- To emphasize the importance of physician-family communication and trust.
- To highlight the role of psychosocial factors in FBD management.
Main Methods:
- Physician-family communication strategies.
- Differential diagnosis including functional pain.
- Assessment of psychosocial history and comorbid conditions.
- Referral for psychological interventions (e.g., CBT).
- Symptom-directed pharmacologic therapy.
Main Results:
- Early introduction of functional pain concept facilitates treatment.
- Identifying psychosocial factors aids in guiding therapy.
- Psychological interventions and pharmacologic therapy can be beneficial.
- Negative diagnostic testing confirms FBD, enabling treatment initiation.
Conclusions:
- Successful pediatric FBD treatment hinges on a strong physician-family relationship.
- Integrating psychosocial assessments and targeted therapies optimizes care.
- A structured diagnostic approach, including ruling out organic causes, is essential.
Abstract:
The successful treatment of pediatric FBD begins during the initial interaction among the patient, family, and physician. It is important that the physician establish a trusting relationship with the family. An early introduction of the concept of functional pain in the differential diagnosis avoids later problems convincing the family that further diagnostic testing is unnecessary. If diagnostic testing is warranted to exclude an organic disorder, it is useful to explain that these tests are being performed to rule out disorders that can present similarly to FBD. Thus, the patient and family recognize that the most likely diagnosis is FBD, and treatment can begin following negative testing. Physicians must account for the role of psychosocial and medical factors that contribute to the expression of illness so as to optimize diagnosis and care. Exploration into the child's psychosocial history can identify a comorbid condition such as anxiety or depression and help guide, specific therapy with psychological interventions, medication, or both. In cases where the abdominal pain is affecting the child's activities of daily living, such as school performance, referral to a psychologist skilled in the use of techniques such as cognitive behavioral therapy may be useful. Symptom-directed pharmacologic therapy can be useful in selected cases.
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