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Do Children With Functional Abdominal Pain Benefit More From a Pain-Specific Cognitive-Behavioral Intervention Than
Petra Warschburger1, Claudia Calvano1,2, Sebastian Becker3
1Department of Psychology, University of Potsdam, Potsdam, Germany.
Insights
Cognitive-behavioral therapy (CBT) showed long-term benefits for children with functional abdominal pain compared to attention control. While both treatments were effective, CBT improved pain intensity, duration, and quality of life over time.
Area of Science:
- Pediatric Gastroenterology
- Behavioral Medicine
- Clinical Psychology
Background:
- Functional abdominal pain is common in children.
- Cognitive-behavioral therapy (CBT) is a potential treatment option.
Purpose of the Study:
- To compare the efficacy of CBT versus an attention control (AC) in children with functional abdominal pain.
- To assess outcomes including pain intensity, duration, frequency, functional disability, quality of life, and coping strategies.
Main Methods:
- A prospective, multicenter, randomized controlled trial (RCT) involving 127 children aged 7-12 years.
- Participants were randomized to either CBT or AC groups.
- Data collected at baseline, post-intervention, and at 3- and 12-month follow-ups.
Main Results:
- No significant difference in primary endpoint (pain intensity) between CBT and AC groups immediately post-intervention.
- However, time trend analyses revealed significantly greater reductions in pain intensity and duration with CBT over 1 year.
- CBT group showed slightly greater long-term benefits in functional disability, quality of life, and coping strategies.
Conclusions:
- Both CBT and AC interventions were effective, highlighting the importance of time and attention.
- Cognitive-behavioral therapy demonstrated superior long-term efficacy for functional abdominal pain in children.
Introduction:
We aimed to compare the efficacy of cognitive-behavioral therapy (CBT) among children with functional abdominal pain with an attention control (AC), hypothesizing the superiority of CBT group intervention regarding pain intensity (primary outcome), pain duration and frequency (further primary outcomes), functional disability, and quality of life and coping strategies (key secondary outcomes).
Methods:
We conducted a prospective, multicenter, randomized controlled efficacy trial (RCT) with 4 time points (before intervention, after intervention, 3-month follow-up, and 12-month follow-up). One hundred twenty-seven children aged 7-12 years were randomized to either the CBT (n = 63; 55.6% girls) or the AC (n = 64; 57.8% girls).
Results:
Primary endpoint analysis of the logarithmized area under the pain intensity curve showed no significant difference between groups (mean reduction = 49.04%, 95% confidence interval [CI] -19.98%-78.36%). Treatment success rates were comparable (adjusted odds ratio = 0.53, 95% CI 0.21-1.34, number needed to treat = 16). However, time trend analyses over the course of 1 year revealed a significantly greater reduction in pain intensity (40.9%, 95% CI 2.7%-64.1%) and pain duration (43.6%, 95% CI 6.2%-66.1%) in the CBT compared with the AC, but not in pain frequency per day (1.2, 95% CI -2.7 to 5.2). In the long term, children in the CBT benefitted slightly more than those in the AC with respect to functional disability, quality of life, and coping strategies.
Discussion:
Both interventions were effective, which underlines the role of time and attention for treatment efficacy. However, in the longer term, CBT yielded more favorable results.
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