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Bradshaw S, Brinkley A, Scanlan B, Hopper L. The burden and impact of recurrent abdominal pain – exploring the understanding and perception of children and their parents. Health Psychol Behav Med 2022; 10:888-912. [PMID: 36186891 PMCID: PMC9518242 DOI: 10.1080/21642850.2022.2121710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Recurrent abdominal pain (RAP) is a common complaint for children and can result in a significantly lower quality of life due to the extent it can interfere with normal life. RAP can also significantly impact the quality of life of parents. This study sought to qualitatively explore parents’ and children’s understanding and perceptions of the burden and impact of RAP. Methods: Semi-structured interviews were conducted with a sample of parent/child dyads or families (N = 5) engaging with a psychology service. Findings: The findings of the inductive thematic analysis revealed four emergent themes common to both parents and children: (1) Perception, understanding and identification of RAP, (2) Contributing factors, (3) Coping mechanisms/pain management strategies, and (4) Impact and burden of RAP. Conclusions: These findings have important clinical implications regarding the identification and management of RAP and may also contribute to improving communication between clinicians, parents and children by providing insight from multiple perspectives into how RAP is experienced.
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Affiliation(s)
- Sam Bradshaw
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Aoife Brinkley
- Children’s Health Ireland (CHI) at Connolly, Dublin, Ireland
| | - Barry Scanlan
- Children’s Health Ireland (CHI) at Connolly, Dublin, Ireland
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
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2
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de Bruijn CM, Rexwinkel R, Gordon M, Sinopoulou V, Benninga MA, Tabbers MM. Dietary interventions for functional abdominal pain disorders in children: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16:359-371. [PMID: 35311425 DOI: 10.1080/17474124.2022.2055547] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Functional abdominal pain disorders (FAPDs) are common among children and are associated with decreased quality of life and school attendance. Several dietary interventions have been suggested to improve symptoms of FAPDs. This systematic review assessed the efficacy and safety of dietary interventions for pediatric FAPDs. DESIGN AND METHODS Electronic databases were searched (inception-October 2021). Systematic reviews or RCTs were included if children (4-18 years) with FAPDs were treated with dietary interventions and compared to placebo, no diet or any other diet. Data extraction and assessment of quality of evidence based on GRADE system was independently performed by two review authors. Outcomes were treatment success, pain intensity and frequency, and withdrawal due to adverse events. RESULTS Twelve articles were included, representing data of 819 pediatric FAPD patients. Trials investigating fibers, FODMAP diet, fructans, fructose-restricted diet, prebiotic (inulin), serum-derived bovine immunoglobulin, and vitamin D supplementation were included. We found very low-certainty evidence that the use of fibers leads to higher treatment success (NNT = 5). CONCLUSION Based on current evidence, the use of fibers can be discussed in daily practice. High-quality intervention trials are highly needed to investigate if other dietary interventions are effective in the treatment of pediatric FAPD.
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Affiliation(s)
- Clara Ma de Bruijn
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands
| | - Robyn Rexwinkel
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | | | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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3
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Frattale I, Ruscitto C, Papetti L, Ursitti F, Sforza G, Moavero R, Ferilli MAN, Tarantino S, Balestri M, Vigevano F, Mazzone L, Valeriani M. Migraine and Its Equivalents: What Do They Share? A Narrative Review on Common Pathophysiological Patterns. Life (Basel) 2021; 11:1392. [PMID: 34947923 PMCID: PMC8705894 DOI: 10.3390/life11121392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 01/02/2023] Open
Abstract
Migraine is the first in order of frequency of the neurological disorders, affecting both adult and paediatric populations. It is also the first cause of primary headaches in children. Migraine equivalents are periodic disorders that can be associated with migraine or considered as prognostic features of a future migraine manifestation. Despite the mechanisms underlying migraine and its equivalents are not entirely clear, several elements support the hypothesis of common pathophysiological patterns shared by these conditions. The aim of this review is thus to analyze the literature in order to highlight which currently known mechanisms may be common between migraine and its equivalents.
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Affiliation(s)
- Ilaria Frattale
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Claudia Ruscitto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Laura Papetti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Fabiana Ursitti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Giorgia Sforza
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Michela Ada Noris Ferilli
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Samuela Tarantino
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Martina Balestri
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Massimiliano Valeriani
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
- Center for Sensory-Motor Interaction, Aalborg University, 9220 Aalborg Øst, Denmark
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4
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Rexwinkel R, de Bruijn CMA, Gordon M, Benninga MA, Tabbers MM. Pharmacologic Treatment in Functional Abdominal Pain Disorders in Children: A Systematic Review. Pediatrics 2021; 147:peds.2020-042101. [PMID: 34045320 DOI: 10.1542/peds.2020-042101] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Functional abdominal pain disorders (FAPDs) are common in childhood, impacting quality of life and school attendance. There are several compounds available for the treatment of pediatric FAPDs, but their efficacy and safety are unclear because of a lack of head-to-head randomized controlled trials (RCTs). OBJECTIVE To systematically review the efficacy and safety of the pharmacologic treatments available for pediatric FAPDs. DATA SOURCES Electronic databases were searched from inception to February 2021. STUDY SELECTION RCTs or systematic reviews were included if the researchers investigated a study population of children (4-18 years) in whom FAPDs were treated with pharmacologic interventions and compared with placebo, no treatment, or any other agent. DATA EXTRACTION Two reviewers independently performed data extraction and assessed their quality. Any interresearcher disagreements in the assessments were resolved by a third investigator. RESULTS Seventeen articles representing 1197 children with an FAPD were included. Trials investigating antispasmodics, antidepressants, antibiotics, antihistaminic, antiemetic, histamine-2-receptor antagonist, 5-HT4-receptor agonist, melatonin, and buspirone were included. No studies were found on treatment with laxatives, antidiarrheals, analgesics, antimigraines, and serotonergics. LIMITATIONS The overall quality of evidence on the basis of the Grading of Recommendations, Assessment, Development and Evaluations system was very low to low. CONCLUSIONS On the basis of current evidence, it is not possible to recommend any specific pharmacologic agent for the treatment of pediatric FAPDs. However, agents such as antispasmodics or antidepressants can be discussed in daily practice because of their favorable treatment outcomes and the lack of important side effects. High-quality RCTs are necessary to provide adequate pharmacologic treatment. For future intervention trials, we recommend using homogenous outcome measures and instruments, a large sample size, and long-term follow-up.
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Affiliation(s)
- Robyn Rexwinkel
- Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; .,Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Academic Medical Center and Emma Children's Hospital, Amsterdam, The Netherlands.,Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and.,Contributed equally as co-first authors
| | - Clara M A de Bruijn
- Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Academic Medical Center and Emma Children's Hospital, Amsterdam, The Netherlands.,Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and.,Contributed equally as co-first authors
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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5
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Abstract
Nearly 20,000 pediatric patients undergo cholecystectomy annually, and abnormal gallbladder emptying ("biliary dyskinesia") has replaced cholelithiasis as the leading indication for this operation in the USA. Nonetheless, patients with abnormal gallbladder emptying nuclear medicine scans do not uniformly benefit from cholecystectomy. This article reviews the available data on presentation, workup and treatment of patients with abnormally low and high rates of gallbladder emptying.
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Affiliation(s)
- M Coluccio
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott St, Buffalo, New York, 14203, USA
| | - A J Claffey
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott St, Buffalo, New York, 14203, USA
| | - D H Rothstein
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott St, Buffalo, New York, 14203, USA; Department of Pediatric Surgery, John R. Oishei Children's Hospital, 818 Ellicott St, Buffalo, New York, 14203, USA.
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6
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Birnie KA, Ouellette C, Do Amaral T, Stinson JN. Mapping the evidence and gaps of interventions for pediatric chronic pain to inform policy, research, and practice: A systematic review and quality assessment of systematic reviews. Can J Pain 2020; 4:129-148. [PMID: 33987493 PMCID: PMC7951164 DOI: 10.1080/24740527.2020.1757384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
Background: Reviews in pediatric chronic pain often focus on only one intervention or population, making it difficult for policymakers and decision makers to quickly synthesize knowledge to inform larger-scale policy and funding priorities. Aims: The aims of this study were to (1) create an evidence and gap map of interventions for pediatric chronic pain and (2) identify gaps between existing evidence and recently identified patient-oriented research priorities. Methods: We performed a systematic review of English-language peer-reviewed systematic reviews or clinical practice guidelines of pediatric chronic pain intervention published in the past 20 years. Database searches of Medline, Embase, PsycINFO, Web of Science, CINAHL, and SCOPUS were conducted inclusive to June 3, 2019. Review quality was assessed using the AMSTAR-2. Results: Of 4168 unique abstracts, 50 systematic reviews (including 2 clinical practice guidelines) crossing diverse pediatric chronic pain populations and intervention settings were included. One third were rated high quality, with half rated low to critically low quality. The largest proportion of reviews addressed psychological and pharmacological interventions, followed by interdisciplinary, other (e.g., dietary), and physical interventions. Most common outcomes included pain, physical, emotional, and role functioning and quality of life. Treatment satisfaction and adverse events were less common, with minimal report of sleep or economic factors. Most patient-oriented research priorities had not been investigated. Conclusions: Sufficient quality evidence is available to guide evidence-informed policies in pediatric chronic pain, most notably regarding psychological and pharmacological interventions. Numerous evidence gaps in patient-oriented research priorities and treatment outcomes should guide prioritization of research funds, as well as study aims and design.
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Affiliation(s)
- Kathryn A. Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Carley Ouellette
- Faculty of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Tamara Do Amaral
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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7
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Eccleston C, Fisher E, Cooper TE, Grégoire MC, Heathcote LC, Krane E, Lord SM, Sethna NF, Anderson AK, Anderson B, Clinch J, Gray AL, Gold JI, Howard RF, Ljungman G, Moore RA, Schechter N, Wiffen PJ, Wilkinson NMR, Williams DG, Wood C, van Tilburg MAL, Zernikow B. Pharmacological interventions for chronic pain in children: an overview of systematic reviews. Pain 2019; 160:1698-1707. [PMID: 31335640 DOI: 10.1097/j.pain.0000000000001609] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We know little about the safety or efficacy of pharmacological medicines for children and adolescents with chronic pain, despite their common use. Our aim was to conduct an overview review of systematic reviews of pharmacological interventions that purport to reduce pain in children with chronic noncancer pain (CNCP) or chronic cancer-related pain (CCRP). We searched the Cochrane Database of Systematic Reviews, Medline, EMBASE, and DARE for systematic reviews from inception to March 2018. We conducted reference and citation searches of included reviews. We included children (0-18 years of age) with CNCP or CCRP. We extracted the review characteristics and primary outcomes of ≥30% participant-reported pain relief and patient global impression of change. We sifted 704 abstracts and included 23 systematic reviews investigating children with CNCP or CCRP. Seven of those 23 reviews included 6 trials that involved children with CNCP. There were no randomised controlled trials in reviews relating to reducing pain in CCRP. We were unable to combine data in a meta-analysis. Overall, the quality of evidence was very low, and we have very little confidence in the effect estimates. The state of evidence of randomized controlled trials in this field is poor; we have no evidence from randomised controlled trials for pharmacological interventions in children with cancer-related pain, yet cannot deny individual children access to potential pain relief. Prospero ID: CRD42018086900.
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Affiliation(s)
- Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Pain, Palliative, and Supportive Care, Oxford University Hospitals, Oxford, United Kingdom
| | - Tess E Cooper
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Elliot Krane
- Department of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, Palo Alto, CA, United States
| | - Susan M Lord
- Children's Complex Pain Service, John Hunter Children's Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Navil F Sethna
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | | | - Brian Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Jacqueline Clinch
- Bristol Royal Children's Hospital, University of Bristol, Bristol, United Kingdom
- Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom
| | - Andrew L Gray
- Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jeffrey I Gold
- Anesthesiology, Pediatrics, and Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Pediatric Pain Management Clinic, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Gustaf Ljungman
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - R Andrew Moore
- Pain Research, Nuffield, Department of Clinical Neurosciences, University of Oxford, The Churchill, Oxford, United Kingdom
| | - Neil Schechter
- Department of Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Philip J Wiffen
- Pain Research, Nuffield, Department of Clinical Neurosciences, University of Oxford, The Churchill, Oxford, United Kingdom
| | - Nick M R Wilkinson
- Department of Paediatrics, Evelina London Children's Hospital, Kings College London, United Kingdom
| | - David G Williams
- The Anaesthetic Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Chantal Wood
- Department of Rheumatology, Chronic Pain Centre, University Hospital of Limoges, University of Limoges, Haute Vienne, France
| | - Miranda A L van Tilburg
- College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, United States
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescent's Hospital, Datteln, Germany
- Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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8
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Mentha: A genus rich in vital nutra‐pharmaceuticals—A review. Phytother Res 2019; 33:2548-2570. [DOI: 10.1002/ptr.6423] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/20/2019] [Accepted: 06/04/2019] [Indexed: 12/11/2022]
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9
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Kim ES, Kwon KT, Kim SK, Kim M, Lee HS, Jang BI, Kim KO, Kim EY, Lee YJ, Hong SJ, Yang CH, Kang B, Choe BH. Impact of Education on School Nurses' Knowledge of Inflammatory Bowel Disease. Gut Liver 2019; 13:48-53. [PMID: 30037169 PMCID: PMC6346995 DOI: 10.5009/gnl18139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/29/2018] [Accepted: 06/17/2018] [Indexed: 11/25/2022] Open
Abstract
Background/Aims School nurses’ knowledge of inflammatory bowel disease (IBD) has not been evaluated. We aimed to investigate school nurses’ knowledge of IBD and determine whether education could improve this knowledge. Methods School nurses were invited to complete self-reported questionnaires on IBD. Then, IBD specialists from tertiary referral hospitals provided a 60-minute lecture with educational brochures on two occasions, with a 3-month interval. Within 6 months after the educational interventions, school nurses were asked to complete the same IBD questionnaire via e-mail. Results Among 101 school nurses who were invited to participate, 54 nurses (53.5%) who completed two consecutive questionnaires were included in this study (median age, 45 years; range, 25 to 59 years; 100% female); 11.1% and 7.4% of the study participants had no knowledge regarding ulcerative colitis and Crohn’s disease, respectively. They had heard of IBD most frequently from doctors (33.3%), followed by internet sources (25.9%). After 6 months, the number of nurses who could explain IBD to students with over 30% confidence increased from 24 (44.5%) to 42 (77.8%) (p<0.001). Most nurses (81.5%) reported that the educational intervention was helpful for managing students with abdominal pain or diarrhea. The number of students who received IBD-related welfare services from the Daegu Metropolitan Office of Education doubled when compared with the corresponding number during the prior educational year. Conclusions There is room for improvement in school nurses’ knowledge of IBD. A systematic educational program on IBD should be implemented for these nurses.
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Affiliation(s)
- Eun Soo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Kook Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Miyoung Kim
- Keimyung University College of Nursing, Daegu, Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Suk Jin Hong
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chang Heon Yang
- Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung-Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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10
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Investigation of vagal afferent functioning using the Heartbeat Event Related Potential. Int J Psychophysiol 2018; 131:113-123. [DOI: 10.1016/j.ijpsycho.2017.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/20/2017] [Accepted: 06/23/2017] [Indexed: 11/19/2022]
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11
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Complex pain in children and young people; part 2: management. BJA Educ 2018; 18:82-88. [DOI: 10.1016/j.bjae.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/22/2022] Open
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12
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Recurring Abdominal Pain in Pediatrics. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Caes L, Orchard A, Christie D. Connecting the Mind-Body Split: Understanding the Relationship between Symptoms and Emotional Well-Being in Chronic Pain and Functional Gastrointestinal Disorders. Healthcare (Basel) 2017; 5:E93. [PMID: 29206152 PMCID: PMC5746727 DOI: 10.3390/healthcare5040093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022] Open
Abstract
Paediatric chronic conditions, e.g., chronic pain and functional gastrointestinal disorders, are commonly diagnosed, with fatigue, pain and abdominal discomfort the most frequently reported symptoms across conditions. Regardless of whether symptoms are connected to an underlying medical diagnosis or not, they are often associated with an increased experience of psychological distress by both the ill child and their parents. While pain and embarrassing symptoms can induce increased distress, evidence is also accumulating in support of a reciprocal relationship between pain and distress. This reciprocal relationship is nicely illustrated in the fear avoidance model of pain, which has recently been found to be applicable to childhood pain experiences. The purpose of this article is to illustrate how mind (i.e., emotions) and body (i.e., physical symptoms) interact using chronic pain and gastrointestinal disorders as key examples. Despite the evidence for the connection between mind and body, the mind-body split is still a dominant position for families and health care systems, as evidenced by the artificial split between physical and mental health care. In a mission to overcome this gap, this article will conclude by providing tools on how the highlighted evidence can help to close this gap between mind and body.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - Alex Orchard
- UCLH NHS Foundation Trust, Child and Adolescent Psychological Services, London NW1 2PQ, UK.
| | - Deborah Christie
- UCLH NHS Foundation Trust, Child and Adolescent Psychological Services, London NW1 2PQ, UK.
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Bonvanie IJ, Kallesøe KH, Janssens KAM, Schröder A, Rosmalen JGM, Rask CU. Psychological Interventions for Children with Functional Somatic Symptoms: A Systematic Review and Meta-Analysis. J Pediatr 2017; 187:272-281.e17. [PMID: 28416243 DOI: 10.1016/j.jpeds.2017.03.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/03/2017] [Accepted: 03/07/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To analyze the effectiveness of psychological treatments on symptom load and associated disability in children with functional somatic symptoms, and to explore potential moderators of effects. STUDY DESIGN Cochrane, PubMed, PsycINFO, EMBASE, and CINAHL were searched for randomized controlled trials published in peer-reviewed journals. Randomized controlled trials studying the effect of a psychological treatment on symptom load and disability in children with functional somatic symptoms were selected. Data on symptom load, disability, and school absence directly post-treatment and at follow-up were extracted by 2 assessors. Studies were appraised with the Cochrane risk of bias tool. Standardized mean differences were pooled in a random-effects model. Heterogeneity in effect-sizes was explored by use of meta-regressions. PROSPERO Registration ID: CRD42015029667. RESULTS Out of 4098 identified records, 27 studies were included in this review of which 21 were included in meta-analyses. Psychological treatments reduced symptom load (Hedges g = -0.61), disability (Hedges g = -0.42), and school absence (Hedges g = -0.51) post-treatment in children suffering from various functional somatic symptoms. Effects were maintained at follow-up. Type and duration of symptoms, age, and treatment dose did not explain heterogeneity in effect-sizes between studies. Effect-sizes should be interpreted with caution because of the variety in outcome measures, unexplained heterogeneity in found effects and potential publication bias. CONCLUSIONS Psychological interventions reduce symptom load, disability, and school absence in children with functional somatic symptoms. Future research should clarify which patient and treatment characteristics modify outcomes.
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Affiliation(s)
- Irma J Bonvanie
- University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
| | - Karen H Kallesøe
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Karin A M Janssens
- University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Judith G M Rosmalen
- University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Charlotte U Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Child and Adolescent Psychiatric Center Risskov, Aarhus University Hospital, Aarhus, Denmark
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15
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Why we need a higher suspicion index of urolithiasis in children. J Pediatr Urol 2017; 13:164-171. [PMID: 28185760 DOI: 10.1016/j.jpurol.2016.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 12/13/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most children with symptoms of urolithiasis and urinary solute excretion abnormalities leading to stone formation have no calculi revealed by ultrasound or X-ray plain film ("occult urolithiasis"). This covers a large group of children presenting with common symptoms such as abdominal pain, hematuria, and dysuria, often faced by general practitioners and pediatricians. However, half or more of children with urolithiasis could present with abdominal/flank pain without specific urinary symptoms. STUDY DESIGN We review the current evidence about prevalence, clinical presentation, and radiological detection of overt and "occult" urolithiasis in children, aiming to give readers the instruments to suspect and diagnose urolithiasis while avoiding cost-ineffective and undue diagnostic procedures. CONCLUSIONS It is important to investigate for urolithiasis first by ultrasound and, in specific cases, by urinary metabolic and different imaging studies in the following groups: 1) in children with non-glomerular hematuria or/and dysuria not presenting inflammation of external genitalia; 2) in children with acute/sub-acute or infrequent recurrent abdominal pain and family history of urolithiasis in first or second degree relatives or being at higher risk of developing stones although hematuria and dysuria are lacking; 3) in children under 8 years old, even though pain is central or diffuse to the whole abdomen; and 4) in children presenting risk factors or conditions predisposing to urolithiasis. Finally, it seems reasonable to repeat ultrasound 1-2 years later also in children with "occult" urolithiasis and high risk of developing stones to detect any (re-)appearance of calculi.
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16
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Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome. Curr Neurol Neurosci Rep 2017; 17:21. [DOI: 10.1007/s11910-017-0731-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Krasaelap A, Madani S. Cyproheptadine: A Potentially Effective Treatment for Functional Gastrointestinal Disorders in Children. Pediatr Ann 2017; 46:e120-e125. [PMID: 28287686 DOI: 10.3928/19382359-20170213-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Functional gastrointestinal disorders (FGIDs) negatively affect children's quality of life and health care costs. It has been proposed that alteration of gut serotonin leads to gastrointestinal dysmotility, visceral hypersensitivity, altered gastrointestinal secretions, and brain-gut dysfunction. Cyproheptadine, a serotonin antagonist, has been shown to be a potentially effective and safe treatment option in children who meet the clinical criteria for FGIDs. Well-designed multicenter trials with long-term follow-up are needed to further investigate its efficacy. [Pediatr Ann. 2017;46(3):e120-e125.].
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Abstract
Mind-body therapies are popular and are ranked among the top 10 complementary and integrative medicine practices reportedly used by adults and children in the 2007-2012 National Health Interview Survey. A growing body of evidence supports the effectiveness and safety of mind-body therapies in pediatrics. This clinical report outlines popular mind-body therapies for children and youth and examines the best-available evidence for a variety of mind-body therapies and practices, including biofeedback, clinical hypnosis, guided imagery, meditation, and yoga. The report is intended to help health care professionals guide their patients to nonpharmacologic approaches to improve concentration, help decrease pain, control discomfort, or ease anxiety.
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19
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Lagman-Bartolome AM, Lay C. Pediatric migraine variants: a review of epidemiology, diagnosis, treatment, and outcome. Curr Neurol Neurosci Rep 2016; 15:34. [PMID: 25903296 DOI: 10.1007/s11910-015-0551-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pediatric migraine variants, previously known as childhood periodic syndromes, migraine equivalents, or migraine precursors, are a group of periodic or paroxysmal disorders occurring in patients who also have migraine with or without aura, or who have an increased likelihood of developing migraine. They have common key clinical features including periodic or paroxysmal character, normal neurological examination between attacks, family history of migraine, and clinical evolution to classic types of migraine. This article aims to review the pathophysiology, evaluation, and management of the pediatric migraine variants including abdominal migraine, benign paroxysmal vertigo, cyclic vomiting syndrome, and benign paroxysmal torticollis as well as the episodic syndromes that may lead to migraine, infantile colic, alternating hemiplegia of childhood, and vestibular migraine.
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Affiliation(s)
- Ana Marissa Lagman-Bartolome
- Headache Medicine, Pediatric Neurology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Canada,
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20
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Devanarayana NM, Rajindrajith S, Benninga MA. Abdominal migraine in children: association between gastric motility parameters and clinical characteristics. BMC Gastroenterol 2016; 16:26. [PMID: 26924750 PMCID: PMC4770524 DOI: 10.1186/s12876-016-0435-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/17/2016] [Indexed: 12/12/2022] Open
Abstract
Background Approximately 0.2–1 % of children suffers from abdominal migraine (AM). Pathophysiology of AM has not been adequately studied. This study evaluated gastric motility in children with AM. Methods Seventeen children (6 boys), within an age range of 4–15 years, referred to a tertiary care paediatric unit, North Colombo Teaching Hospital Ragama, Sri Lanka, from 2007 to 2012, were screened. Those fulfilling Rome III criteria for AM were recruited after obtaining parental consent. None had clinical or laboratory evidence of organic disorders. Twenty healthy children (8 boys), with an age range of 4–14 years, were recruited as controls. Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound method. Results Average GE (41.6 % vs. 66.2 %, in controls), amplitude of antral contractions (A) (57.9 % vs. 89.0 %) and antral motility index (MI) (5.0 vs. 8.3) were lower and fasting antral area (1.8 cm2 vs. 0.6 cm2) was higher in children with AM (p < 0.01). No significant difference in the frequency of antral contractions (F) (8.8/3 min vs. 9.3/3 min, p = 0.08) was found between the two groups. Scores obtained for severity of abdominal pain had a negative correlation with A (r = −0.55, p = 0.03). Average duration of abdominal pain episodes correlated with GE (r = −0.58, p = 0.02). Negative correlations were observed between duration of AM and A (r = −0.55), F (r = −0.52), and MI (r = −0.57) (p < 0.05). Conclusions GE and antral motility parameters were significantly lower in children with AM. A significant correlation was found between symptoms and gastric motility. These findings suggest a possible role of abnormal gastric motility in the pathogenesis of AM.
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Affiliation(s)
- Niranga Manjuri Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka.
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Castelnuovo G, Giusti EM, Manzoni GM, Saviola D, Gatti A, Gabrielli S, Lacerenza M, Pietrabissa G, Cattivelli R, Spatola CAM, Corti S, Novelli M, Villa V, Cottini A, Lai C, Pagnini F, Castelli L, Tavola M, Torta R, Arreghini M, Zanini L, Brunani A, Capodaglio P, D'Aniello GE, Scarpina F, Brioschi A, Priano L, Mauro A, Riva G, Repetto C, Regalia C, Molinari E, Notaro P, Paolucci S, Sandrini G, Simpson SG, Wiederhold B, Tamburin S. Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation. Front Psychol 2016; 7:115. [PMID: 26924998 PMCID: PMC4759289 DOI: 10.3389/fpsyg.2016.00115] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.
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Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | | | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Faculty of Psychology, eCampus UniversityNovedrate (Como), Italy
| | - Donatella Saviola
- Cardinal Ferrari Rehabilitation Center, Santo Stefano Rehabilitation IstituteFontanellato, Italy
| | | | | | | | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Chiara A. M. Spatola
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Stefania Corti
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Margherita Novelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Valentina Villa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | | | - Carlo Lai
- Department of Dynamic and Clinical PsychologySapienza University of Rome, Italy
| | - Francesco Pagnini
- Department of Psychology, Catholic University of MilanMilan, Italy
- Department of Psychology, Harvard UniversityCambridge, MA, USA
| | - Lorys Castelli
- Department of Psychology, University of TurinTurin, Italy
| | | | - Riccardo Torta
- Department of Neuroscience “Rita Levi Montalcini”University of Turin, Italy
| | - Marco Arreghini
- Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Loredana Zanini
- Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Amelia Brunani
- Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Paolo Capodaglio
- Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Guido E. D'Aniello
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Federica Scarpina
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Neuroscience “Rita Levi Montalcini”University of Turin, Italy
| | - Andrea Brioschi
- Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Lorenzo Priano
- Department of Neuroscience “Rita Levi Montalcini”University of Turin, Italy
- Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Alessandro Mauro
- Department of Neuroscience “Rita Levi Montalcini”University of Turin, Italy
- Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Giuseppe Riva
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Claudia Repetto
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Camillo Regalia
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Paolo Notaro
- “Pain Center II Level - Department of Surgery” - ASST Grande Ospedale Metropolitano NiguardaMilano, Italy
| | | | - Giorgio Sandrini
- Department of Brain and Behavioral Sciences, C. Mondino National Neurological Institute, University of PaviaPavia, Italy
| | - Susan G. Simpson
- School of Psychology, Social Work and Social PolicyUniversity of South Australia, Australia
| | | | - Stefano Tamburin
- Department of Neurological and Movement Sciences, University of VeronaVerona, Italy
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Swain MS, Henschke N, Kamper SJ, Gobina I, Ottová-Jordan V, Maher CG. Pain and Moderate to Vigorous Physical Activity in Adolescence: An International Population-Based Survey. PAIN MEDICINE 2015; 17:813-819. [PMID: 26350061 DOI: 10.1111/pme.12923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 06/04/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether individual types of pain (headache, stomach-ache, and backache) or multiple pains affect the odds of young people achieving the recommended 60 minutes of moderate to vigorous physical activity (MVPA) per day in a large representative sample. DESIGN Multicenter cross-sectional survey. SETTING Twenty-eight countries across Europe and North America. SUBJECTS Adolescents (N = 242,103). METHODS An analysis of data collected in two waves (2001/02 and 2005/06) of the health behavior in school-aged children (HBSC) study was performed. Survey questions included the HBSC symptoms checklist and the amount of regular physical activity. Multilevel logistic regression was used to account for clustering effect of MVPA within countries. Models investigated the relationship between pain and physical activity, adjusted for the HBSC study year. Six models were conducted separately for gender and age-group (11, 13, and 15 years) strata. RESULTS In general, the presence of pain was associated with reduced physical activity. Headache alone was associated with reduced physical activity in all six strata (odd ratios 0.77-0.84), stomach-ache alone in five strata (0.77-0.92), and backache alone in four strata (0.86-0.96). In 11- and 13-year-old girls, headache, stomach-ache, and backache, individually and in combination, were associated with decreased odds of being physically active (odds ratios ranging from 0.73 to 0.91). Within the other four age and gender strata, the relationship was less consistent. CONCLUSION Pain is associated with reduced physical activity in adolescents but this association varies according to gender, age, and the type of pain experienced.
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Affiliation(s)
- Michael Steven Swain
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Nicholas Henschke
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Institute of Public Health, Heidelberg Medical School, University of Heidelberg, Heidelberg, Germany
| | - Steven James Kamper
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Epidemiology and Biostatistics, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Inese Gobina
- Department of Public Health and Epidemiology, Riga Stradinš University, Latvia
| | - Veronika Ottová-Jordan
- Department of Child and Adolescent Psychiatry, Research Unit Child Public Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Gerard Maher
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
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23
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Draeger-Muenke R. Functional Abdominal Pain: "Get" the Function, Loose the Pain. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 58:34-62. [PMID: 26046716 DOI: 10.1080/00029157.2015.1031208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Functional abdominal pain is a mind-body, psychosocial, and self-reinforcing experience with significant consequences for the sufferer and the surrounding support network. The occurrence of unpredictable symptoms and their severity add an element of dread and feeling out-of-control to daily life and often reduce overall functioning in a downward spiral. Two clinical presentations of functional abdominal pain are offered in this article (composites to protect confidentiality) dealing with abdominal pain syndrome and abdominal migraines. The treatment demonstrates the use of hypnotic principles for self-regulation, exploration, and meaning-making. Hypnosis treatment is conducted in combination with mindfulness-based interventions and Traditional Chinese Medicine's (TCM) teachings regarding abdominal health and illness. The clinical examples illustrate medical findings that suggest children with early life stress and an early onset of gastrointestinal somatization may not simply outgrow their functional abdominal pain but may suffer into adulthood.
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24
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Asgarshirazi M, Shariat M, Dalili H. Comparison of the Effects of pH-Dependent Peppermint Oil and Synbiotic Lactol (Bacillus coagulans + Fructooligosaccharides) on Childhood Functional Abdominal Pain: A Randomized Placebo-Controlled Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e23844. [PMID: 26023339 PMCID: PMC4443394 DOI: 10.5812/ircmj.17(4)2015.23844] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/15/2015] [Accepted: 03/28/2015] [Indexed: 12/13/2022]
Abstract
Background: Still there is no consensus on the best treatment for abdominal pain-related functional Gastrointestinal Disorders (FGIDs). Objectives: The purpose of this study was to compare the effects of a synbiotic Lactol (Bacillus coagulans + fructooligosaccharide (FOS)), peppermint oil (Colpermin) and placebo (folic acid) on abdominal pain-related FGIDs except for abdominal migraine. Patients and Methods: This placebo-controlled study was conducted on 120 children aged 4 - 13 years to compare the efficacy of pH-dependent peppermint oil (Colpermin) versus synbiotic Lactol (Bacillus coagulans + fructooligosaccharids (FOS)) in decreasing duration, severity and frequency of functional abdominal pain. The patients were randomly allocated into three equal groups (n = 40 in each group) and each group received Colpermin or Lactol or placebo. Results: Eighty-eight out of 120 enrolled patients completed a one-month protocol and analyses were performed on 88 patients’ data. Analyses showed that improvement in pain duration, frequency and severity in the Colpermin group was better than the placebo group (P = 0.0001, P = 0.0001 and P = 0.001, respectively). Moreover, pain duration and frequency were decreased in the Lactol group more than the placebo (P = 0.012 and P = 0.0001, respectively), but changes in pain severity were not significant (P = 0.373). Colpermin was superior to Lactol in decreasing pain duration and severity (P = 0.040 and P = 0.013, respectively). No known side effects or intolerance were seen with Colpermin or Lactol. Conclusions: The pH-dependent peppermint oil capsule and Lactol tablet (Bacillus coagulans+ FOS) as synbiotics seem to be superior to placebo in decreasing the severity, duration and frequency of pain in abdominal pain-related functional GI disorders.
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Affiliation(s)
- Masoumeh Asgarshirazi
- Pediatric Department, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Masoumeh Asgarshirazi, Pediatric Department, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166581596, Fax: +98-2166591315, E-mail:
| | - Mamak Shariat
- Maternal-Fetal and Neonatal Research Center, Family Health Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hosein Dalili
- Breastfeeding Research Center, Family Health Institute, Tehran University of Medical Sciences, Tehran, IR Iran
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25
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Messerer B, Krauss-Stoisser B, Urlesberger B. [Non-pharmaceutical measures, topical analgesics and oral administration of glucose in pain management: Austrian interdisciplinary recommendations on pediatric perioperative pain management]. Schmerz 2015; 28:31-42. [PMID: 24550025 DOI: 10.1007/s00482-014-1391-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Non-pharmaceutical procedures are increasingly being used in pediatric pain therapy in addition to pharmaceutical procedures and have a supporting function. This article describes the non-pharmaceutical procedures which have an influence on perioperative and posttraumatic pain in children and adolescents. Prerequisites for every adequate pain therapy are affection, imparting a feeling of security, distraction and the creation of a child-oriented environment. Topical analgesics are indicated for application to intact skin for surface anesthesia. For a safe use consideration must be given to the duration of application, the dose and the maximum area of skin treated in an age-dependent manner. For simple but painful procedures in premature infants, neonates and infants, pain can be effectively reduced by the oral administration of glucose. The positive effect is guaranteed particularly for the use in a once only pain stimulation. Non-nutritive sucking, swaddling, facilitated tucking and kangaroo mother care, for example can be used as supportive measures during slightly painful procedures. There is insufficient evidence for a pain reducing effect in older infants and small children. Physical therapeutic procedures can be used as accompanying measures for acute pain and are individually adapted. However, the limited amount of currently available data is insufficient to make a critical scientific assessment of the individual measures. The effects can, however, be observed in the daily routine practice. Psychological methods can facilitate coping with pain. In situations with mental and psychiatric comorbidities or psychosocial impairment, a psychologist should be consulted. Acupuncture and hypnosis are also a meaningful addition within the framework of multimodal pain therapy.
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Affiliation(s)
- B Messerer
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich,
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26
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Spiri D, Rinaldi VE, Titomanlio L. Pediatric migraine and episodic syndromes that may be associated with migraine. Ital J Pediatr 2014; 40:92. [PMID: 25928129 PMCID: PMC4239406 DOI: 10.1186/s13052-014-0092-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/07/2014] [Indexed: 01/03/2023] Open
Abstract
Importance Migraine is a common disorder and a frequent cause of medical consultation in children. Many childhood episodic syndromes have been described as common precursors of migraine. Objective To review current knowledge on migraine and childhood episodic syndromes, and to discuss future directions for research and clinical practice. Findings For most children it is difficult to describe a headache and fully verbalize symptoms such as photophobia and phonophobia that must be inferred from behaviour. Classical migraine features are rare before the age of 6 years, but some migraine-related syndromes have been described. Benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of childhood, cyclic vomiting syndrome and abdominal migraine are currently classified as childhood episodic syndromes, and therefore common precursors of migraine. A strong association between infantile colic and migraine has recently been reported. There are similarities between children with episodic syndromes and children with migraine, regarding social and demographic factors, precipitating and relieving factors, and accompanying gastrointestinal, neurologic, and vasomotor features. The real pathophysiological mechanisms of migraine are not fully understood. Current data obtained through molecular and functional studies provide a complex model in which vascular and neurologic events cooperate in the pathogenesis of migraine attacks. Genetic factors causing disturbances in neuronal ion channels, make a migraineur more sensitive to multiple trigger factors that activate the nociception cascade. The expanding knowledge on migraine genetics and pathophysiology may be applicable to childhood episodic syndromes. Migraine preventive strategies are particularly important in children, and could be beneficial in childhood episodic syndromes. Nonspecific analgesics like ibuprofen and acetaminophen are widely used in pediatrics to control pain and have been found to be effective also in the treatment of acute migraine attacks. Triptans are the specific fist-line drugs for acute migraine treatment. Conclusions and relevance Migraine phenotype differs somewhat in the developing brain, and childhood episodic syndromes may arise before typical migraine headache. Diagnosing pediatric migraine may be difficult because of children’s language and cognitive abilities. The risk of underestimating migraine in pediatric age is high. An adequate diagnosis is important to maintain a good quality of life and to avoid inappropriate therapy.
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Affiliation(s)
- Daniele Spiri
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy.
| | - Victoria Elisa Rinaldi
- Department of Pediatrics, Università degli Studi di Perugia, Perugia, Italy. .,Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France.
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France. .,Pediatric Migraine and Neurovascular Diseases Unit, APHP-Hospital Robert Debré, Paris, France. .,Pediatric Emergency Department, Robert Debré University Hospital, 48, Bld Sérurier, Paris, 75019, France.
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Warschburger P, Calvano C, Becker S, Friedt M, Hudert C, Posovszky C, Schier M, Wegscheider K. Stop the pain: study protocol for a randomized-controlled trial. Trials 2014; 15:357. [PMID: 25212457 PMCID: PMC4171565 DOI: 10.1186/1745-6215-15-357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/26/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Functional abdominal pain (FAP) is not only a highly prevalent disease but also poses a considerable burden on children and their families. Untreated, FAP is highly persistent until adulthood, also leading to an increased risk of psychiatric disorders. Intervention studies underscore the efficacy of cognitive behavioral treatment approaches but are limited in terms of sample size, long-term follow-up data, controls and inclusion of psychosocial outcome data. METHODS/DESIGN In a multicenter randomized controlled trial, 112 children aged 7 to 12 years who fulfill the Rome III criteria for FAP will be allocated to an established cognitive behavioral training program for children with FAP (n = 56) or to an active control group (focusing on age-appropriate information delivery; n = 56). Randomization occurs centrally, blockwise and is stratified by center. This study is performed in five pediatric gastroenterology outpatient departments. Observer-blind assessments of outcome variables take place four times: pre-, post-, 3- and 12-months post-treatment. Primary outcome is the course of pain intensity and frequency. Secondary endpoints are health-related quality of life, pain-related coping and cognitions, as well as self-efficacy. DISCUSSION This confirmatory randomized controlled clinical trial evaluates the efficacy of a cognitive behavioral intervention for children with FAP. By applying an active control group, time and attention processes can be controlled, and long-term follow-up data over the course of one year can be explored. TRIAL REGISTRATION DRKS00005038 (date: 25 July 2013); NCT02030392 (date: 7 January 2014).
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Affiliation(s)
- Petra Warschburger
- />Department Psychology, Counseling Psychology, University of Potsdam, Karl-Liebknecht-Straße 24-25, Potsdam, 14476 Germany
| | - Claudia Calvano
- />Department Psychology, Counseling Psychology, University of Potsdam, Karl-Liebknecht-Straße 24-25, Potsdam, 14476 Germany
| | - Sebastian Becker
- />Paediatric Gastroenterology, Princess Margaret Children’s Hospital Darmstadt, Dieburger Str. 31, Darmstadt, 64287 Germany
| | - Michael Friedt
- />Department of General Paediatrics, Neonatology and Paediatric Cardiology, Division of Paediatric Gastroenterology, University Children’s Hospital, Moorenstr. 5, Duesseldorf, D-40225 Germany
| | - Christian Hudert
- />Department of Gastroenterology, Charité University Medicine, Virchow Campus, Augustenburger Platz 1, Berlin, 13353 Germany
| | - Carsten Posovszky
- />Department of Paediatrics and Adolescent Medicine, University Medical, Centre Ulm, Eythstr. 24, 89075 Ulm, Germany
| | - Maike Schier
- />Department of Gastroenterology, Catholic Children’s Hospital Wilhelmstift, Hamburg, Germany
| | - Karl Wegscheider
- />Department of Medical Biometry and Epidemiology, University Medical, Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246 Germany
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Fisher E, Heathcote L, Palermo TM, de C Williams AC, Lau J, Eccleston C. Systematic review and meta-analysis of psychological therapies for children with chronic pain. J Pediatr Psychol 2014; 39:763-82. [PMID: 24602890 PMCID: PMC4148613 DOI: 10.1093/jpepsy/jsu008] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This systematic review and meta-analysis examined the effects of psychological therapies for management of chronic pain in children. METHODS Randomized controlled trials of psychological interventions treating children (<18 years) with chronic pain conditions including headache, abdominal, musculoskeletal, or neuropathic pain were searched for. Pain symptoms, disability, depression, anxiety, and sleep outcomes were extracted. Risk of bias was assessed and quality of the evidence was rated using GRADE. RESULTS 35 included studies revealed that across all chronic pain conditions, psychological interventions reduced pain symptoms and disability posttreatment. Individual pain conditions were analyzed separately. Sleep outcomes were not reported in any trials. Optimal dose of treatment was explored. For headache pain, higher treatment dose led to greater reductions in pain. No effect of dosage was found for other chronic pain conditions. CONCLUSIONS Evidence for psychological therapies treating chronic pain is promising. Recommendations for clinical practice and research are presented.
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Affiliation(s)
- Emma Fisher
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Lauren Heathcote
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Tonya M Palermo
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Amanda C de C Williams
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Jennifer Lau
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
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Rutten JMTM, Vlieger AM, Frankenhuis C, George EK, Groeneweg M, Norbruis OF, Tjon a Ten W, Van Wering H, Dijkgraaf MGW, Merkus MP, Benninga MA. Gut-directed hypnotherapy in children with irritable bowel syndrome or functional abdominal pain (syndrome): a randomized controlled trial on self exercises at home using CD versus individual therapy by qualified therapists. BMC Pediatr 2014; 14:140. [PMID: 24894077 PMCID: PMC4060754 DOI: 10.1186/1471-2431-14-140] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/30/2014] [Indexed: 12/15/2022] Open
Abstract
Background Irritable bowel syndrome (IBS) and functional abdominal pain (syndrome) (FAP(S)) are common pediatric disorders, characterized by chronic or recurrent abdominal pain. Treatment is challenging, especially in children with persisting symptoms. Gut-directed hypnotherapy (HT) performed by a therapist has been shown to be effective in these children, but is still unavailable to many children due to costs, a lack of qualified child-hypnotherapists and because it requires a significant investment of time by child and parent(s). Home-based hypnotherapy by means of exercises on CD has been shown effective as well, and has potential benefits, such as lower costs and less time investment. The aim of this randomized controlled trial (RCT) is to compare cost-effectiveness of individual HT performed by a qualified therapist with HT by means of CD recorded self-exercises at home in children with IBS or FAP(S). Methods/Design 260 children, aged 8-18 years with IBS or FAP(S) according to Rome III criteria are included in this currently conducted RCT with a follow-up period of one year. Children are randomized to either 6 sessions of individual HT given by a qualified therapist over a 3-month period or HT through self-exercises at home with CD for 3 months. The primary outcome is the proportion of patients in which treatment is successful at the end of treatment and after one year follow-up. Treatment success is defined as at least 50% reduction in both abdominal pain frequency and intensity scores. Secondary outcomes include adequate relief, cost-effectiveness and effects of both therapies on depression and anxiety scores, somatization scores, QoL, pain beliefs and coping strategies. Discussion If the effectiveness of home-based HT with CD is comparable to, or only slightly lower, than HT by a therapist, this treatment may become an attractive form of therapy in children with IBS or FAP(S), because of its low costs and direct availability. Trial registration Dutch Trial Register number NTR2725 (date of registration: 1 February 2011)
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Affiliation(s)
- Juliette M T M Rutten
- Department of Pediatric Gastroenterology, Emma Children's Hospital/Academic Medical Center, PO Box 22700, 1100 DD Amsterdam, The Netherlands.
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Eccleston C, Palermo TM, Williams ACDC, Lewandowski Holley A, Morley S, Fisher E, Law E. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2014; 2014:CD003968. [PMID: 24796681 PMCID: PMC5886855 DOI: 10.1002/14651858.cd003968.pub4] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This is an update of the original Cochrane review first published in Issue 1, 2003, and previously updated in 2009 and 2012. Chronic pain affects many children, who report severe pain, disability, and distressed mood. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This update focuses specifically on psychological therapies delivered face-to-face, adds new randomised controlled trials (RCTs), and additional data from previously included trials. OBJECTIVES There were three objectives to this review. First, to determine the effectiveness on clinical outcomes of pain severity, disability, depression, and anxiety of psychological therapy delivered face-to-face for chronic and recurrent pain in children and adolescents compared with active treatment, waiting-list, or standard medical care. Second, to evaluate the impact of psychological therapies on depression and anxiety, which were previously combined as 'mood'. Third, we assessed the risk of bias of the included studies and the quality of outcomes using the GRADE criteria. SEARCH METHODS Searches were undertaken of CENTRAL, MEDLINE, EMBASE, and PsycINFO. We searched for further RCTs in the references of all identified studies, meta-analyses, and reviews. Trial registry databases were also searched. The date of most recent search was January 2014. SELECTION CRITERIA RCTs with at least 10 participants in each arm post-treatment comparing psychological therapies with active treatment, standard medical care, or waiting-list control for children or adolescents with episodic, recurrent or persistent pain were eligible for inclusion. Only trials conducted in person (face-to-face) were considered. Studies that delivered treatment remotely were excluded from this update. DATA COLLECTION AND ANALYSIS All included studies were analysed and the quality of outcomes were assessed. All treatments were combined into one class, psychological treatments. Pain conditions were split into headache and non-headache. Both conditions were assessed on four outcomes: pain, disability, depression, and anxiety. Data were extracted at two time points; post-treatment (immediately or the earliest data available following end of treatment) and at follow-up (between three and 12 months post-treatment). MAIN RESULTS Seven papers were identified in the updated search. Of these papers, five presented new trials and two presented follow-up data for previously included trials. Five studies that were previously included in this review were excluded as therapy was delivered remotely. The review thus included a total of 37 studies. The total number of participants completing treatments was 2111. Twenty studies addressed treatments for headache (including migraine); nine for abdominal pain; two for mixed pain conditions including headache pain, two for fibromyalgia, two for recurrent abdominal pain or irritable bowel syndrome, and two for pain associated with sickle cell disease.Analyses revealed psychological therapies to be beneficial for children with chronic pain on seven outcomes. For headache pain, psychological therapies reduced pain post-treatment and at follow-up respectively (risk ratio (RR) 2.47, 95% confidence interval (CI) 1.97 to 3.09, z = 7.87, p < 0.01, number needed to treat to benefit (NNTB) = 2.94; RR 2.89, 95% CI 1.03 to 8.07, z = 2.02, p < 0.05, NNTB = 3.67). Psychological therapies also had a small beneficial effect at reducing disability in headache conditions post-treatment and at follow-up respectively (standardised mean difference (SMD) -0.49, 95% CI -0.74 to -0.24, z = 3.90, p < 0.01; SMD -0.46, 95% CI -0.78 to -0.13, z = 2.72, p < 0.01). No beneficial effect was found on depression post-treatment (SMD -0.18, 95% CI -0.49 to 0.14, z = 1.11, p > 0.05). At follow-up, only one study was eligible, therefore no analysis was possible and no conclusions can be drawn. Analyses revealed a small beneficial effect for anxiety post-treatment (SMD -0.33, 95% CI -0.61 to -0.04, z = 2.25, p < 0.05). However, this was not maintained at follow-up (SMD -0.28, 95% CI -1.00 to 0.45; z = 0.75, p > 0.05).Analyses revealed two beneficial effects of psychological treatment for children with non-headache pain. Pain was found to improve post-treatment (SMD -0.57, 95% CI -0.86 to -0.27, z = 3.74, p < 0.01), but not at follow-up (SMD -0.11, 95% CI -0.41 to 0.19, z = 0.73, p > 0.05). Psychological therapies also had a beneficial effect for disability post-treatment (SMD -0.45, 95% CI -0.71 to -0.19, z = 3.40, p < 0.01), but this was not maintained at follow-up (SMD -0.35, 95% CI -0.71 to 0.02, z = 1.87, p > 0.05). No effect was found for depression or anxiety post-treatment (SMD -0.07, 95% CI -0.30 to 0.17, z = 0.54, p > 0.05; SMD -0.15, 95% CI -0.36 to 0.07, z = 1.33, p > 0.05) or at follow-up (SMD 0.06, 95% CI -0.16 to 0.28, z = 0.53, p > 0.05; SMD 0.05, 95% CI -0.24 to 0.33, z = 0.32, p > 0.05). AUTHORS' CONCLUSIONS Psychological treatments delivered face-to-face are effective in reducing pain intensity and disability for children and adolescents (<18 years) with headache, and therapeutic gains appear to be maintained, although this should be treated with caution for the disability outcome as only two studies could be included in the follow-up analysis. Psychological therapies are also beneficial at reducing anxiety post-treatment for headache. For non-headache conditions, psychological treatments were found to be beneficial for pain and disability post-treatment but these effects were not maintained at follow-up. There is limited evidence available to estimate the effects of psychological therapies on depression and anxiety for children and adolescents with headache and non-headache pain. The conclusions of this update replicate and add to those of the previous review which found that psychological therapies were effective in reducing pain intensity for children with headache and non-headache pain conditions, and these effects were maintained at follow-up for children with headache conditions.
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Affiliation(s)
| | - Tonya M Palermo
- University of WashingtonAnesthesiology and Pain MedicineP.O. Box 5371, M/S CW‐8SeattleUSA98145
| | - Amanda C de C Williams
- University College LondonResearch Department of Clinical, Educational & Health PsychologyGower StreetLondonUKWC1E 6BT
| | - Amy Lewandowski Holley
- Department of Pediatrics Oregon Health & Science UniversityInstitute on Development & DisabilityPortlandUSA
| | - Stephen Morley
- University of LeedsLeeds Institute of Health SciencesCharles Thackrah Building101 Clarendon RoadLeedsUKLS2 9LJ
| | - Emma Fisher
- Seattle Children’s Research InstituteChild Health, Behaviour, and Development2001 8th Avenue, Suite 400SeattleUSA
| | - Emily Law
- University of WashingtonAnesthesiology and Pain MedicineP.O. Box 5371, M/S CW‐8SeattleUSA98145
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Huertas‐Ceballos AA, Logan S, Bennett C, Macarthur C. WITHDRAWN: Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev 2014; 2014:CD003014. [PMID: 24532211 PMCID: PMC10687505 DOI: 10.1002/14651858.cd003014.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This Review is being updated and replaced following the publication of a new Protocol (Martin AE, Newlove‐Delgado TV, Abbott RA, Bethel A, Thompson‐Coon J, Nikolaou v, Logan S. Psychosocial interventions for recurrent abdominal pain in childhood (Protocol). Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD010971. DOI: 10.1002/14651858.CD010971). It will remain withdrawn when the new Review is published. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
| | - Stuart Logan
- University of ExeterPeninsula CLAHRC, University of Exeter Medical SchoolVeysey BuildingSalmon Pool LaneExeterUKEX2 4SG
| | - Cathy Bennett
- Plymouth University Peninsula Schools of Medicine and DentistryThe John Bull Building, Tamar Science Park, Research WayPlymouthUKPL6 8BU
| | - Colin Macarthur
- The Hospital for Sick ChildrenClinical Health Evaluative Sciences555 University AvenueTorontoOntarioCanadaM5G 1X8
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Abstract
Recurrent abdominal pain in childhood is common, and continues to be a diagnostic and therapeutic challenge. It is usually attributed to a functional gastrointestinal disorder rather than an organic disease. In most cases, a comprehensive history and physical examination should enable one to make a positive diagnosis of functional disorder. The presence of alarm symptoms and signs, such as weight loss, gastrointestinal bleeding and chronic severe diarrhoea, warrants further investigations and referral to a paediatric gastrointestinal specialist. The mainstay of therapy in functional abdominal pain is education, reassurance and avoidance of triggering factors. While symptom-based pharmacological therapy may be helpful in patients who do not respond to simple management, it is best used on a time-limited basis due to the lack of good evidence of its efficacy. The primary goal of therapy is a return to normal daily activities rather than complete elimination of pain. In recalcitrant cases, psychological interventions such as cognitive behaviour therapy and relaxation training have proven to be efficacious.
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Affiliation(s)
- Fang Kuan Chiou
- Gastroenterology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
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Rome III criteria in parents' hands: pain-related functional gastrointestinal disorders in community children and associations with somatic complaints and mental health. Eur J Gastroenterol Hepatol 2013; 25:1223-9. [PMID: 24002016 DOI: 10.1097/meg.0b013e328364b55d] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine (a) the prevalence of Rome III abdominal pain-related functional gastrointestinal disorders in a western community sample of children, (b) their associations with sociodemographic factors, and (c) whether children fulfilling Rome III abdominal pain diagnoses show higher rates of psychological distress and somatization. METHODS Data were collected from parents of 6-10-year-old children who were recruited from 22 public grammar schools in Germany. A total of 1537 questionnaires were included in the analysis. Abdominal pain-related functional gastrointestinal disorders were diagnosed on the basis of questionnaire responses by Rome III criteria. Further, somatic complaints as well as emotional and behavioral problems were assessed. RESULTS In total, 7.7% of children aged 6-10 years fulfilled the criteria for at least one Rome III abdominal pain-related functional gastrointestinal disorder according to their parents. The most prevalent diagnoses were irritable bowel syndrome (4.9%) and functional abdominal pain (2.0%). Assigned diagnoses were not associated with sociodemographic factors. We could confirm that abdominal pain-related functional disorders, especially irritable bowel syndrome, were strongly associated with somatization and emotional problems in community. CONCLUSION Rome III abdominal pain-related functional gastrointestinal disorders are a common health problem in children and are, even in community, strongly associated with other somatic complaints and psychological distress.
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Horvath A, Dziechciarz P, Szajewska H. Systematic review of randomized controlled trials: fiber supplements for abdominal pain-related functional gastrointestinal disorders in childhood. ANNALS OF NUTRITION AND METABOLISM 2013; 61:95-101. [PMID: 22889919 DOI: 10.1159/000338965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/18/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND A lack of safe and reliable treatments for abdominal pain-related functional gastrointestinal disorders (FGIDs) has prompted interest in new therapies. AIM To systematically evaluate the effect of dietary fibers for treating abdominal pain-related FGIDs in children. METHODS In December 2011, MEDLINE, EMBASE and the Cochrane Library were searched for randomized controlled trials (RCTs) evaluating fiber supplementation in children with FGIDs. RESULTS Only 3 RCTs were identified, which enrolled a total of 167 children and adolescents (5–17 years old) with recurrent abdominal pain. Only 1 study used the Rome III criteria. Patients were supplemented with different dietary fiber types for 4–6 weeks. The use of dietary fibers did not influence the proportion of responders to treatment, and improvement did not occur in reported clinically relevant outcomes such as no pain or a significant decrease in pain intensity (risk ratio 1.17, 95% confidence interval 0.75–1.81). CONCLUSION There is no evidence that supplementation with fiber as a dietary manipulation may be useful for treating children with FGIDs. However, one should not overlook the fact that the main limitation for recommendation of the routine fiber use in clinical practice derives from the weak quality and paucity of available studies.
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Affiliation(s)
- Andrea Horvath
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
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Leitsymptome und Differenzialdiagnostik. PÄDIATRISCHE GASTROENTEROLOGIE, HEPATOLOGIE UND ERNÄHRUNG 2013. [PMCID: PMC7498817 DOI: 10.1007/978-3-642-24710-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Die Vorstellung eines Kindes mit akuten Bauchschmerzen erfolgt meist kurz nach Schmerzbeginn, nicht selten nachts und zu Zeiten eingeschränkter Diagnostik. Erschwert ist die Diagnosefindung durch fehlende Verbalisierung der Schmerzen bei Kleinkindern und Säuglingen sowie durch vage und wenig präzise Angaben zu Schmerzcharakter und Lokalisation bei älteren Kindern.
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Eccleston C, Palermo TM, de C Williams AC, Lewandowski A, Morley S, Fisher E, Law E. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2012; 12:CD003968. [PMID: 23235601 PMCID: PMC3715398 DOI: 10.1002/14651858.cd003968.pub3] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic pain affects many children, who report severe pain, distressed mood, and disability. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This update adds recently published randomised controlled trials (RCTs) to the review published in 2009. OBJECTIVES To assess the effectiveness of psychological therapies, principally cognitive behavioural therapy and behavioural therapy, for reducing pain, disability, and improving mood in children and adolescents with recurrent, episodic, or persistent pain. We also assessed the risk of bias and methodological quality of the included studies. SEARCH METHODS Searches were undertaken of MEDLINE, EMBASE, and PsycLIT. We searched for RCTs in references of all identified studies, meta-analyses and reviews. Date of most recent search: March 2012. SELECTION CRITERIA RCTs with at least 10 participants in each arm post-treatment comparing psychological therapies with active treatment were eligible for inclusion (waiting list or standard medical care) for children or adolescents with episodic, recurrent or persistent pain. DATA COLLECTION AND ANALYSIS All included studies were analysed and the quality of the studies recorded. All treatments were combined into one class: psychological treatments; headache and non-headache outcomes were separately analysed on three outcomes: pain, disability, and mood. Data were extracted at two time points; post-treatment (immediately or the earliest data available following end of treatment) and at follow-up (at least three months after the post-treatment assessment point, but not more than 12 months). MAIN RESULTS Eight studies were added in this update of the review, giving a total of 37 studies. The total number of participants completing treatments was 1938. Twenty-one studies addressed treatments for headache (including migraine); seven for abdominal pain; four included mixed pain conditions including headache pain, two for fibromyalgia, two for pain associated with sickle cell disease, and one for juvenile idiopathic arthritis. Analyses revealed five significant effects. Pain was found to improve for headache and non-headache groups at post-treatment, and for the headache group at follow-up. Mood significantly improved for the headache group at follow-up, although, this should be interpreted with caution as there were only two small studies entered into the analysis. Finally, disability significantly improved in the non-headache group at post-treatment. There were no other significant effects. AUTHORS' CONCLUSIONS Psychological treatments are effective in reducing pain intensity for children and adolescents (<18 years) with headache and benefits from therapy appear to be maintained. Psychological treatments also improve pain and disability for children with non-headache pain. There is limited evidence available to estimate the effects of psychological therapies on mood for children and adolescents with headache and non-headache pain. There is also limited evidence to estimate the effects on disability in children with headache. These conclusions replicate and add to those of the previous review which found psychological therapies were effective in reducing pain intensity for children with headache and non-headache pain conditions, and these effects were maintained at follow-up.
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Enhanced auditory brainstem response and parental bonding style in children with gastrointestinal symptoms. PLoS One 2012; 7:e32913. [PMID: 22470430 PMCID: PMC3310045 DOI: 10.1371/journal.pone.0032913] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 02/03/2012] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The electrophysiological properties of the brain and influence of parental bonding in childhood irritable bowel syndrome (IBS) are unclear. We hypothesized that children with chronic gastrointestinal (GI) symptoms like IBS may show exaggerated brainstem auditory evoked potential (BAEP) responses and receive more inadequate parental bonding. METHODOLOGY/PRINCIPAL FINDINGS Children aged seven and their mothers (141 pairs) participated. BAEP was measured by summation of 1,000 waves of the electroencephalogram triggered by 75 dB click sounds. The mothers completed their Children's Somatization Inventory (CSI) and Parental Bonding Instrument (PBI). CSI results revealed 66 (42%) children without GI symptoms (controls) and 75 (58%) children with one or more GI symptoms (GI group). The III wave in the GI group (median 4.10 interquartile range [3.95-4.24] ms right, 4.04 [3.90-4.18] ms left) had a significantly shorter peak latency than controls (4.18 [4.06-4.34] ms right, p = 0.032, 4.13 [4.02-4.24] ms left, p = 0.018). The female GI group showed a significantly shorter peak latency of the III wave (4.00 [3.90-4.18] ms) than controls (4.18 [3.97-4.31] ms, p = 0.034) in the right side. BAEP in the male GI group did not significantly differ from that in controls. GI scores showed a significant correlation with the peak latency of the III wave in the left side (rho = -0.192, p = 0.025). The maternal care PBI scores in the GI group (29 [26]-[33]) were significantly lower than controls (31 [28.5-33], p = 0.010), while the maternal over-protection PBI scores were significantly higher in the GI group (16 [12]-[17]) than controls (13 [10.5-16], p = 0.024). Multiple regression analysis in females also supported these findings. CONCLUSIONS It is suggested that children with chronic GI symptoms have exaggerated brainstem responses to environmental stimuli and inadequate parental behaviors aggravate these symptoms.
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Burns JW, Day MA, Thorn BE. Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive-behavioral therapy for chronic pain? Transl Behav Med 2012; 2:22-9. [PMID: 24073095 PMCID: PMC3717814 DOI: 10.1007/s13142-011-0086-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Mechanisms underlying favorable outcomes of psychosocial interventions for chronic pain are unclear. Theory suggests changes in maladaptive cognitions represent therapeutic mechanisms specific to cognitive-behavioral therapy (CBT). We illustrate the importance of examining whether treatments work either uniquely via mechanisms specified by theory or via mechanisms common to different treatments. Secondary data analysis was conducted to examine the effects of reduction in pain catastrophizing on outcomes following CBT and Pain Education. Generally, reductions in pain catastrophizing were significantly related to outcome improvements irrespective of CBT or Pain Education condition. Results underscore the need to assess whether mechanisms presumed to operate specifically in one treatment do indeed predict outcomes and illustrate the importance of broadening the assessment of mechanisms beyond those specified by theory. Theory-specific, competing, and common mechanisms must all be assessed to determine why our treatments work.
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Affiliation(s)
- John W Burns
- />Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL USA
| | - Melissa A Day
- />The Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall 505 Hackberry Lane, Tuscaloosa, AL 35487-0348 USA
| | - Beverly E Thorn
- />The Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall 505 Hackberry Lane, Tuscaloosa, AL 35487-0348 USA
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Ishizaki Y, Yasujima H, Takenaka Y, Shimada A, Murakami K, Fukai Y, Inouwe N, Oka T, Maru M, Wakako R, Shirakawa M, Fujita M, Fujii Y, Uchida Y, Ogimi Y, Kambara Y, Nagai A, Nakao R, Tanaka H. Japanese clinical guidelines for chronic pain in children and adolescents. Pediatr Int 2012; 54:1-7. [PMID: 22168460 DOI: 10.1111/j.1442-200x.2011.03543.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic pain is a common problem in pediatric practice. The prevalence of chronic pain in children is >30%. Because pain indicates emotional expression as well as the physiological reaction toward infection, injury, and inflammation, both physiological and psychological assessments are essential to determine primary interventions for chronic pain. The Japanese Society of Psychosomatic Pediatrics Task Force of clinical practice guidelines for chronic pain in children and adolescents compiled clinical evidence and opinions of specialists associated with the primary care of pediatric chronic pain in the Japanese 'clinical guidelines for chronic pain in children and adolescents' in 2009, which are presented herein. The guidelines consist of three domains: general introduction to chronic pain; chronic abdominal pain; and chronic headache. Each section contains information on the physiological mechanism, psychological aspects, assessment methods, and primary interventions for pediatric chronic pain. These guidelines are expected to help disseminate knowledge on primary interventions for chronic pain in children and adolescents.
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Affiliation(s)
- Yuko Ishizaki
- Department of Pediatrics, Kansai Medical University, Moriguchi, Japan.
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Clinical presentation and metabolic features of overt and occult urolithiasis. Pediatr Nephrol 2012; 27:101-7. [PMID: 21688190 DOI: 10.1007/s00467-011-1940-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 05/27/2011] [Accepted: 05/27/2011] [Indexed: 12/14/2022]
Abstract
Although pediatricians are frequently confronted with patients presenting urolithiasis symptoms without obvious stones, the syndrome of occult urolithiasis may be still viewed with some skepticism. We have compared the clinical and metabolic features of 197 children with obvious calculi, 189 with microcalculi (diameter ≤ 3 mm based on renal sonography), and 114 with symptoms of urolithiasis and normal renal sonography findings. Only microcalculi and normal sonography subjects with a urinary abnormality potentially leading to urolithiasis were included in the study. Age at presentation increased significantly (p = 0.0001) in the groups in the order normal sonography to microcalculi to calculi groups. There was no significant difference among the three groups in terms of family history of urolithiasis, gender distribution, and degree of hypercalciuria, hyperuricosuria, hyperoxaluria, or hypocitraturia. The average frequency of pain attacks of patients with recurrent abdominal pain (RAP) ranged from 3.6 to 4.6 days of pain per month among the three groups, which is four to ninefold lower than that reported for children with functional or organic gastrointestinal RAP. The consistency of many clinical and urinary metabolic characteristics indicates a common underlying disorder in overt and occult urolithiasis. The increase of age at presentation from the normal sonography to microcalculi and calculi groups may reflect progressive crystal accretion leading ultimately to overt stone formation.
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Weydert JA. Recurring Abdominal Pain in Pediatrics. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00097-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Day MA, Thorn BE, Burns JW. The Continuing Evolution of Biopsychosocial Interventions for Chronic Pain. J Cogn Psychother 2012. [DOI: 10.1891/0889-8391.26.2.114] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the last several decades, great strides have been made in the treatment of persistent painful conditions. The scope of treatment has shifted from purely biomedical, including approaches built upon cognitive, behavioral, and social psychological principles. This article reports and discusses several key paradigm shifts that fueled this revolutionary change in the management of chronic pain. The progressive development of theoretical metamodels and treatment conceptualizations is presented. Cognitive behavioral therapy (CBT) is the most widely accepted biopsychosocial treatment for chronic pain and is founded upon a rich theoretical tradition. The CBT rationale, and empirical evidence to support its efficacy, is presented. The emergence and promise of mindfulness-based and acceptance-based interventions is also discussed. The article concludes with the assertion that future treatment outcome research should focus on understanding the treatment-specific and common factors associated with efficacy.
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Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, McConley R, Ward LC, Cabbil C. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain 2011; 152:2710-2720. [PMID: 21920668 PMCID: PMC3215913 DOI: 10.1016/j.pain.2011.07.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/27/2011] [Accepted: 07/12/2011] [Indexed: 11/16/2022]
Abstract
Chronic pain is a common and costly experience. Cognitive behavioral therapies (CBT) are efficacious for an array of chronic pain conditions. However, the literature is based primarily on urban (white) samples. It is unknown whether CBT works in low-socioeconomic status (SES) minority and nonminority groups. To address this question, we conducted a randomized controlled trial within a low-SES, rural chronic pain population. Specifically, we examined the feasibility, tolerability, acceptability, and efficacy of group CBT compared with a group education intervention (EDU). We hypothesized that although both interventions would elicit short- and long-term improvement across pain-related outcomes, the cognitively-focused CBT protocol would uniquely influence pain catastrophizing. Mixed design analyses of variance were conducted on the sample of eligible participants who did not commence treatment (N=26), the intention-to-treat sample (ITT; N=83), and the completer sample (N=61). Factors associated with treatment completion were examined. Results indicated significantly more drop-outs occurred in CBT. ITT analyses showed that participants in both conditions reported significant improvement across pain-related outcomes, and a nonsignificant trend was found for depressed mood to improve more in CBT than EDU. Results of the completer analyses produced a similar pattern of findings; however, CBT produced greater gains on cognitive and affect variables than EDU. Treatment gains were maintained at 6-month follow-up (N=54). Clinical significance of the findings and the number of treatment responders is reported. Overall, these findings indicate that CBT and EDU are viable treatment options in low-SES minority and nonminority groups. Further research should target disseminating and sustaining psychosocial treatment options within underserved populations.
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Affiliation(s)
- Beverly E. Thorn
- The Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
| | - Melissa A. Day
- The Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
| | - John Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Melissa C. Kuhajda
- Department of Psychiatry and Behavioral Medicine, The University of Alabama School of Medicine, Tuscaloosa, AL
| | - Susan W. Gaskins
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama
| | - Kelly Sweeney
- The Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
| | | | - L. Charles Ward
- Psychology Service, V.A. Medical Center, Tuscaloosa, Alabama
| | - Chalanda Cabbil
- The Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
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Sood MR, Di Lorenzo C, Hyams J, Miranda A, Simpson P, Mousa H, Nurko S. Beliefs and attitudes of general pediatricians and pediatric gastroenterologists regarding functional gastrointestinal disorders: a survey study. Clin Pediatr (Phila) 2011; 50:891-6. [PMID: 21464079 DOI: 10.1177/0009922811398041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Manu R Sood
- Medical College of Wisconsin, Milwaukee, WI, USA.
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Sprenger L, Gerhards F, Goldbeck L. Effects of psychological treatment on recurrent abdominal pain in children - a meta-analysis. Clin Psychol Rev 2011; 31:1192-7. [PMID: 21871242 DOI: 10.1016/j.cpr.2011.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 07/21/2011] [Accepted: 07/23/2011] [Indexed: 12/14/2022]
Abstract
Recurrent abdominal pain in children has a high prevalence, thought to be about 10%. Untreated, there is a high risk that the symptoms become chronic and may lead in some cases to co-morbid mental disorders. Evidence-based treatments are therefore urgently needed. The objective of this study was to examine the effectiveness of psychological therapies for pain reduction in children with recurrent abdominal pain (RAP) by a meta-analysis of intervention studies. Ten controlled studies fulfilling minimum methodical criteria were included. The results of the analysis showed that psychological therapies, mainly cognitive-behavioural, have a moderate effect on the reduction of pain in children with RAP. After analysing homogeneity and significance with the fixed effect model, the medium effect size, calculated with Hedges g, was 0.58 (σ=0.16), demonstrating highly significant (p<.01) effects. The study showed that psychological therapies are effective in treating children with chronic abdominal pain. The empirical basis in this field needs to be broadened.
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Affiliation(s)
- Linda Sprenger
- University Hospital Marburg and Gießen, Department for Child and Adolescent Psychiatry/Psychotherapy, Schützenstraße 49, D-35039 Marburg, Germany.
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von Baeyer CL. Understanding and managing children's recurrent pain in primary care: A biopsychosocial perspective. Paediatr Child Health 2011; 12:121-5. [PMID: 19030351 DOI: 10.1093/pch/12.2.121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2006] [Indexed: 11/13/2022] Open
Abstract
Recurrent pains in childhood are those that occur at least three times within three months and interfere with daily activities. The most common reasons for pain are headaches and abdominal pain, and the great majority of these have no serious or treatable physical cause. Instead, a functional analysis of the antecedents and consequences of the pain for the child is needed. This requires time, trust, rapport and acceptance, as well as the development of a shared biopsychosocial understanding of the pain. Some interview questions are suggested for this purpose. These include questions about the physical and social triggers of pain episodes, such as stress at school or at home, and modelling of pain behaviour by family members. Also included are questions about the adverse consequences of pain, such as sleep problems, difficulty in concentration, avoidance of responsibility and of feared situations, and inadvertent reinforcement of pain behaviour by solicitous behaviour on the part of parents. Among the numerous interventions for recurrent pain, those that promote learning of relaxation skills are the best established. A cognitive-behavioural, biopsychosocial approach to treating recurrent pain is well supported by research evidence. Primary care physicians and paediatric consultants can help to prevent and relieve children's recurrent pain.
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Affiliation(s)
- Carl L von Baeyer
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan
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Eccleston C, Clinch J. Adolescent chronic pain and disability: A review of the current evidence in assessment and treatment. Paediatr Child Health 2011; 12:117-20. [PMID: 19030350 DOI: 10.1093/pch/12.2.117] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2006] [Indexed: 12/13/2022] Open
Abstract
Adolescents who suffer from chronic pain also report complex syndrome-associated disability and distress that can detrimentally affect the quality of their lives and the lives of their family members. Over the past 10 years, there have been significant developments in both methods of assessment and in treatment programs. There have also been good developments in clinical assessment tools, although many need further study. However, the evidence base of available treatments remains small, and there is an urgent need for new trials in both pharmacological and nonpharmacological treatments. The greatest challenges are organizational, and the concern is how to bring patients in contact with available treatments. Many patients who could benefit from evidence-supported treatments are not currently able to access treatment. Theoretical developments aimed at explaining chronic pain within the context of the family, as well as family attempts at coping with complex disability, are underway.
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Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G. Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents. Cochrane Database Syst Rev 2011; 2011:CD008013. [PMID: 21735420 PMCID: PMC6769179 DOI: 10.1002/14651858.cd008013.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abdominal pain-related functional gastrointestinal disorders (FGIDs) are among the most common medical problems in paediatric medicine. Frequently, physicians prescribe antidepressants as a second-line treatment for children and adolescents with FGIDs. To date, the evidence on the benefits and harms of antidepressants for the treatment of abdominal pain-related FGIDs has not been assessed systematically. OBJECTIVES The primary objectives were to conduct a systematic review to evaluate the efficacy and safety of antidepressants for the treatment of abdominal pain-related FGIDs in children and adolescents. SEARCH STRATEGY We searched The Cochrane Library, PubMed, EMBASE, IPA, CINAHL, PsycINFO, ISI Web of Science, Biosis Previews and the International Clinical Trials Registry Platform of the World Health Organization with appropriate filters (from inception to January 31, 2011). SELECTION CRITERIA For efficacy we included double-blind, randomised controlled trials (RCTs) of antidepressants for treatment of abdominal pain-related FGIDs in children and adolescents 18 years or younger. Open-label and uncontrolled experimental studies, as well as observational studies were eligible for the assessment of harms. The minimum study duration was 4 weeks. The minimum study size was 30 participants. DATA COLLECTION AND ANALYSIS Two authors independently assessed all abstracts and full text articles, and rated the risk of bias for included studies. Data were extracted independently by one author and checked for accuracy by another author. Data were analysed using RevMan 5. MAIN RESULTS Two RCTs (123 participants), both using amitriptyline, met the pre-specified inclusion criteria. These studies provided mixed findings on the efficacy of amitriptyline for the treatment of abdominal pain-related FGIDs. The larger, publicly-funded study reported no statistically significant difference in efficacy between amitriptyline and placebo in 90 children and adolescents with FGIDs after 4 weeks of treatment. On intention-to-treat (ITT)- analysis, 59% of the children reported feeling better in the amitriptyline group compared with 53% in the placebo group (RR 1.12; 95% CI: 0.77 to 1.63; P = 0.54). The risk of bias for this study was rated as low.The second RCT enrolled 33 adolescents with irritable bowel syndrome. Patients receiving amitriptyline experienced greater improvements in the primary outcome, overall quality of life, at weeks 6, 10, and 13 compared with those on placebo (P= 0.019, 0.004, and 0.013, respectively). No effect estimates were calculated for the quality of life outcome because mean quality of life scores and standard deviations were not reported. For most secondary outcomes no statistically significant differences between amitriptyline and placebo could be detected. The risk of bias for this study was rated as unclear for most items. However, it was rated as high for other bias due to multiple testing. The results of this study should be interpreted with caution due to the small number of patients and multiple testing.The larger study reported mild adverse events including fatigue, rash and headache and dizziness. On ITT analysis, 4% of the amitriptyline group experienced at least one adverse event compared to 2% of the placebo group. There was no statistically significant difference in the proportion of patients who experienced at least one adverse event (RR 1.91; 95% CI 0.18 to 20.35; P = 0.59). The smaller study reported no adverse events. The methods of adverse effects assessment was poorly reported in both studies and no clear conclusions on the risks of harms of amitriptyline can be drawn. AUTHORS' CONCLUSIONS Clinicians must be aware that for the majority of antidepressant medications no evidence exists that supports their use for the treatment of abdominal pain-related FGIDs in children and adolescents. The existing randomised controlled evidence is limited to studies on amitriptyline and revealed no statistically significant differences between amitriptyline and placebo for most efficacy outcomes. Amitriptyline does not appear to provide any benefit for the treatment of FGIDs in children and adolescents. Studies in children with depressive disorders have shown that antidepressants can lead to substantial, sometimes life-threatening adverse effects. Until better evidence evolves, clinicians should weigh the potential benefits of antidepressant treatment against known risks of antidepressants in paediatric patients.
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Affiliation(s)
- Angela Kaminski
- Danube University KremsDepartment for Evidence‐based Medicine and Clinical EpidemiologyDr.‐Karl‐Dorrek‐Strasse 30KremsAustria3500
| | - Adrian Kamper
- Children's Hospital of SalzburgDepartment of Psychosomatic Medicine for Children and AdolescentsParacelsus Medical UniversitySalzburgAustria
| | - Kylie Thaler
- Danube University KremsDepartment for Evidence‐based Medicine and Clinical EpidemiologyDr.‐Karl‐Dorrek‐Strasse 30KremsAustria3500
| | - Andrea Chapman
- Danube University KremsDepartment for Evidence‐based Medicine and Clinical EpidemiologyDr.‐Karl‐Dorrek‐Strasse 30KremsAustria3500
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Abstract
Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder.
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Warner CM, Colognori D, Kim RE, Reigada LC, Klein RG, Browner-Elhanan KJ, Saborsky A, Petkova E, Reiss P, Chhabra M, McFarlane-Ferreira YB, Phoon CK, Pittman N, Benkov K. Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial. Depress Anxiety 2011; 28:551-9. [PMID: 21681863 PMCID: PMC3128648 DOI: 10.1002/da.20821] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 03/22/2011] [Accepted: 03/29/2011] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. METHODS Children and adolescents (aged 8-16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were randomly assigned to a cognitive-behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting list control. RESULTS TAPS was found to be an acceptable treatment for this population and was superior to the waiting list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self- and parent ratings indicated reductions in children's somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains 3 months following treatment. CONCLUSIONS The study supports the feasibility and preliminary efficacy of a cognitive-behavioral intervention targeting co-occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children's dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments.
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Affiliation(s)
- Carrie Masia Warner
- Department of Child and Adolescent Psychiatry, NYU Child Study Center, New York, New York 10016, USA.
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