CBT effective in treating functional abdominal pain disorders in children: JAMA

Functional abdominal pain disorders (FAPDs) can severely affect the lives of children and their families, with symptoms carrying into adulthood. Management of FADP symptoms is also a financial and time burden to clinicians and health care systems.

A study was conducted to systematically review various randomized clinical trials (RCTs) on the outcomes of cognitive-behavioural therapy (CBT), educational support, yoga, hypnotherapy, gut-directed hypnotherapy, guided imagery, and relaxation in the management of FAPDs.

Pairs of the authors independently extracted data from all included studies, using a predesigned data extraction sheet. One author acted as arbitrator. Risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of the evidence for all primary outcomes was analyzed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Primary outcomes were treatment success, pain frequency, pain intensity, and withdrawal owing to adverse events. Dichotomous outcomes were expressed as risk ratio (RR) with corresponding 95% CIs. Continuous outcomes were expressed as mean difference (MD) or standardized MD with 95% CI.

The results of the study are:

A total of 33 RCTs with 2657 children were included.

Twelve studies compared CBT with no intervention, 5 studies compared CBT with educational support, 3 studies compared yoga with no intervention, 2 studies compared hypnotherapy with no intervention, 2 studies compared gut-directed hypnotherapy with hypnotherapy, and 2 studies compared guided imagery with relaxation.

Seven studies evaluated other unique comparisons (eg, visceral osteopathy vs normal osteopathy). Per the GRADE framework, owing to risk of bias, there was moderate certainty in evidence that CBT was associated with higher treatment success numbers, lower pain frequency, and lower pain intensity than no intervention.

Owing to high imprecision, there was low certainty in evidence that there was no difference between CBT and educational support for pain intensity

Owing to the risk of bias and imprecision, there was low certainty in evidence that hypnotherapy resulted in higher treatment success compared with no intervention

Owing to the risk of bias and imprecision, there was low certainty in evidence that yoga had similar treatment success to no intervention

Thus, the results of this systematic review and meta-analysis suggest that CBT and hypnotherapy may be considered as a treatment for FAPDs in childhood. Future RCTs should address quality issues to enhance the overall certainty of the results, and studies should consider targeting these interventions toward patients who are more likely to respond.

Reference:

Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children A Systematic Review and Meta-analysis by Morris Gordon, et. al published by JAMA Pediatrics.

doi:10.1001/jamapediatrics.2022.0313

Keywords:

Morris Gordon, Vassiliki Sinopoulou, Merit Tabbers, Robyn Rexwinkel, Clara de Bruijn, Terence Dovey, Marco Gasparetto, Helen Vanker, MD5; Marc Benninga, JAMA Pediatrics, Psychosocial Interventions, Treatment, Functional, Abdominal Pain Disorders, Children