In a retrospective chart review conducted by the division of pediatric gastroenterology of Atlantic Health System in Morristown, NJ, researchers evaluated the effectiveness of cognitive behavioral therapy (ie, guided image therapy and relaxation techniques) in the treatment of childhood functional abdominal pain. After excluding organic causes of abdominal pain, 18 patients (mean age, 12.1 ± 4.9 years, 12 male) with functional abdominal pain underwent weekly sessions of cognitive behavioral therapy (mean number of treatments per patient, 4.3 ± 3.4). Following this therapy, abdominal pain improved in 89% of patients. Patients had fewer weekly pain episodes (decreased from 5.5 ± 2.7 to 2.0 ± 2.7), decreased pain intensity (from 2.7 ± 0.6 to 0.6 ± 0.7 on a 0–3 scale), fewer missed school days (from 4.6 ± 1.7 to 1.4 ± 3.2 days/month), and increased social activity participation (from 0.3 ± 0.6 to 1.3 ± 0.6 activities/week) (P<.05 for all). The mean number of physician contacts per year also decreased from a mean of 24.0 to 8.7 (P=.07). The number of patients taking amitriptyline decreased from 14 to 4 after completion of the behavioral therapy (P<.02). The authors concluded that guided imagery and relaxation therapy can effectively reduce chronic functional abdominal pain in children.
Recurrent abdominal pain, a common pediatric complaint, generally falls under the rubric of functional gastrointestinal disorders. Although now more clearly defined utilizing the Rome II criteria,1 extensive work-up to exclude underlying organic disease is frequently undertaken. The Rome II criteria represent the second edition of an expert consensus for diagnosing and treating functional gastrointestinal disorders based on specific, symptom-based diagnostic criteria. Antidepressant medications are increasingly prescribed despite uncertain efficacy.2 The current study supports earlier work3,4 suggesting that complementary therapeutic techniques such as relaxation and guided imagery may provide substantive pain relief. Consultation with a psychologist for cognitive behavioral therapy appears to offer a promising, non-invasive, and safe alternative for patients, parents, and pediatricians.