van der Veek
, et al
Cognitive behavior therapy for pediatric functional abdominal pain: a randomized controlled trial
; doi:

Investigators in the Netherlands conducted a randomized controlled trial to investigate the effectiveness of a 6-session cognitive behavior therapy (CBT) protocol compared with 6 visits to a pediatrician or pediatric gastroenterologist (intensive medical care [IMC]) for the treatment of pediatric functional abdominal pain (FAP). For the study, children aged 7 to 18 years who met the standardized Rome III criteria for FAP were enrolled and randomized to either the CBT or IMC treatment group. CBT was delivered primarily by trained master’s degree students in psychology. Pediatrician-delivered IMC consisted of parent and child education and advice regarding FAP, including diet, activity, and medication, if indicated. Assessments were performed pretreatment, posttreatment, and at 6- and 12-month follow-up. The primary outcome was level of abdominal pain (AP) as reported on questionnaires and diaries. Secondary outcomes included other gastrointestinal complaints, functional disability, other somatic complaints, anxiety, depression, and quality of life.

Data were analyzed on 104 study children, with 52 randomized to each of the 2 treatment groups. Both CBT and IMC resulted in a significant and essentially equal decrease in AP (P < .001). According to the questionnaire-derived data 1 year after treatment, 60% of children who received CBT had significantly improved or recovered, versus 56.4% of children receiving IMC (P = .47). When diary-derived data was used, improvement was identified in 65.8% of children receiving CBT versus 62.8% of those receiving IMC (P = .14). For nearly all secondary outcomes improvement was noted in study children.

The authors conclude that in children with FAP, CBT was as effective as IMC in reducing their pain.

Drs Hagin and LeLeiko have disclosed no financial relationship relevant to this commentary. The commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

FAP is a common and costly pediatric problem, accounting for up to 40% to 50% of visits to pediatric gastroenterologists. There is some evidence that CBT might be an effective treatment, but unequivocal evidence in support of CBT for the treatment of FAP is lacking (see related article, AAP Grand Rounds, January 2010;23[1]:4).

The present RCT was designed to control for the therapeutic effect of receiving increased attention by comparing a 6-session CBT protocol with 6 sessions of intensified medical care. Based on reliable change indices, both groups demonstrated similar improvement in FAP symptoms over time. At 12 months following treatment there was no statistically significant difference between the 2 groups in the number of patients using health care for FAP.

There are several weaknesses in the design of the present study that limit interpretation of the results. The study design did not include a “no treatment” control group, limiting the ability to determine how much of...

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