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Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood
A Huertas-Ceballos1, S Logan, C Bennett
1EGA Hospital, Neonatal Unit, UCLH, Huntley Street, London, UK WC1E 6DH. Angela.Huertas-Ceballos@uclh.nhs.uk
Insights
Cognitive behavioral therapy shows promise for treating recurrent abdominal pain in children. While trials were small, results suggest it
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Evidence-Based Medicine
Background:
- Recurrent abdominal pain (RAP) affects 4-25% of school-age children, often without identifiable organic causes.
- Psychosocial interventions, including cognitive behavioral therapy, are recommended for managing RAP in children.
Purpose of the Study:
- To evaluate the effectiveness of psychosocial interventions for recurrent abdominal pain or irritable bowel syndrome (IBS) in school-age children.
Main Methods:
- Comprehensive literature search across multiple databases (CENTRAL, MEDLINE, EMBASE, etc.) from inception to December 2006.
- Inclusion of randomized trials comparing psychosocial treatments to standard care or waitlists in children meeting RAP or Rome II criteria.
- Independent screening, data extraction, and analysis using RevMan 4.2.10.
Main Results:
- Six randomized trials with 167 participants investigated cognitive behavioral interventions.
- Five studies demonstrated statistically significant pain reduction in children receiving cognitive behavioral therapy compared to control groups.
- One trial had insufficient data for interpretable results due to a mixed patient group.
Conclusions:
- Despite small sample sizes and methodological weaknesses in the included trials, consistent evidence suggests cognitive behavioral therapy may be beneficial for childhood RAP.
- Cognitive behavioral therapy offers a potentially useful intervention for recurrent abdominal pain in children.
- Most children with RAP, especially in primary care, may improve with reassurance and time.
Background:
Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are managed by reassurance and simple measures, a large range of psychosocial interventions including cognitive and behavioural treatments and family therapy have been recommended.
Objectives:
To determine the effectiveness of psychosocial interventions for recurrent abdominal pain or IBS in school-age children.
Search Strategy:
The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2006), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters.
Selection Criteria:
Any study in which the majority of participants were school-age children fulfilling standard criteria for RAP (Apley or the Rome II criteria for functional gastrointestinal diseases) , randomly allocated to any psychosocial treatment compared to standard care or waiting list, were selected.
Data Collection And Analysis:
References identified by the searches were independently screened against the inclusion criteria by two reviewers. Data were extracted and analysed using RevMan 4.2.10.
Main Results:
Six randomised trials (including a total of 167 participants) of cognitive behavioural interventions were identified, with data reported in ten papers. Five studies reported statistically significant improvements in pain, measured in a variety of ways, in children randomised to receive interventions based on cognitive behavioural therapy compared to children on wait lists or receiving standard medical care (Duarte 2006; Humphreys 1998; Robins 2005; Sanders 1989; Sanders 1994). The remaining trial (Hicks 2003) included a wider group of children with recurrent pain and too few with only RAP to provide interpretable data.
Authors' Conclusions:
The included trials were small, with methodological weaknesses and a number failed to give appropriate detail regarding numbers of children assessed. In spite of these methodological weaknesses and the clinical heterogeneity, the consistency and magnitude of the effects reported provides some evidence that cognitive behavioural therapy may be a useful intervention for children with recurrent abdominal pain although most children, particularly in primary care, will improve with reassurance and time.
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