Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood: Cochrane systematic review
Assessed as up to date: 2006/12/01
Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are managed by reassurance and simple measures, a large range of psychosocial interventions including cognitive and behavioural treatments and family therapy have been recommended.Objectives
To determine the effectiveness of psychosocial interventions for recurrent abdominal pain or IBS in school-age children.Search methods
The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2006), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched with appropriate filters.Selection criteria
Any study in which the majority of participants were school-age children fulfilling standard criteria for RAP (Apley or the Rome II criteria for functional gastrointestinal diseases) , randomly allocated to any psychosocial treatment compared to standard care or waiting list, were selected.Data collection and analysis
References identified by the searches were independently screened against the inclusion criteria by two reviewers. Data were extracted and analysed using RevMan 4.2.10.Main results
Six randomised trials (including a total of 167 participants) of cognitive behavioural interventions were identified, with data reported in ten papers. Five studies reported statistically significant improvements in pain, measured in a variety of ways, in children randomised to receive interventions based on cognitive behavioural therapy compared to children on wait lists or receiving standard medical care (Duarte 2006; Humphreys 1998; Robins 2005; Sanders 1989; Sanders 1994). The remaining trial (Hicks 2003) included a wider group of children with recurrent pain and too few with only RAP to provide interpretable data.Authors' conclusions
The included trials were small, with methodological weaknesses and a number failed to give appropriate detail regarding numbers of children assessed. In spite of these methodological weaknesses and the clinical heterogeneity, the consistency and magnitude of the effects reported provides some evidence that cognitive behavioural therapy may be a useful intervention for children with recurrent abdominal pain although most children, particularly in primary care, will improve with reassurance and time.
Huertas-Ceballos Angela A, Logan Stuart, Bennett Cathy, Macarthur Colin
Psychosocial interventions for children who have stomach ache without an organic cause
Between 4% and 25% of school age children complain of stomach aches / recurrent abdominal pain (RAP) which is severe enough to interfere with their daily activities. For most such children, no organic cause for their pain can be found on physical examination or investigation. Although most children are likely to be managed by reassurance and simple measures, a large range of interventions including dietary manipulation, some medicines and psychological interventions has been recommended. Recently it has been suggested that children previously described as having RAP should be classified according to the pattern of symptoms into a series of sub-groups (the Rome II criteria) including irritable bowel syndrome, functional dyspepsia, functional abdominal pain and abdominal migraine. It is not clear whether these categories describe conditions that really differ in either aetiology or responsiveness to treatment . This review attempted to determine the effectiveness of psychosocial interventions. We found 6 studies (including 167 children), all of which examined interventions broadly based on cognitive behavioural therapy (CBT) and no trials of other types of psychosocial interventions. Five of these trials had interpretable results, although lack of important data and / or clinical differences in either intervention or control groups prevented us from combining them statistically. The included trials were relatively small and had some weaknesses in design and reporting. Each of the included studies reported a statistically significant benefit to participants in the intervention group. CBT may therefore be worth considering for some children with recurrent abdominal pain, but this review points to the need for further, better-quality research.
Implications for practice
The natural history of RAP suggests that most children with this condition are likely to improve with reassurance and time. For children with more severe or continuing problems, or who do not respond to other forms of treatment, the evidence from this review suggests that it may be appropriate to consider interventions based on cognitive behavioural therapy. That said, the evidence of effectiveness is relatively weak.
Implications for research
The pathogenesis of recurrent abdominal pain in children remains unclear (Hyams 1995). There is an urgent need for further trials of the many interventions that have been suggested for use in this condition. Such trials are needed not only to guide the management of children with RAP but also to provide information on potential aetiological pathways. Given the difficulty thus far in providing convincing evidence relating to the aetiology of postulated sub-groups it will be important in future trials of interventions to consider designs which allow examination of differential responsiveness according to the clinical picture.Get full text at The Cochrane Library
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