Functional abdominal pain disorders (FAPDs) can be divided into four subcategories (functional dyspepsia, irritable bowel syndrome, abdominal migraine and functional abdominal pain not otherwise specified). These painful conditions can severely affect the quality of life of children and their families, including reduced school/work attendance and performance. The management of FAPD can be time-consuming and financially costly for families and health care teams, with many children continuing to present symptoms as adults.
This systematic review aimed to estimate the effects of psychosocial interventions compared to no intervention or any control on outcomes treatment success, pain frequency, pain intensity, and withdrawal owing to adverse events in children (aged 4-18 years) with FAPD.
This systematic review registered their study protocol before data collection. Sensitive searches performed in five databases (including PubMed and the Cochrane Library) and three trial registries were used to identify randomised controlled trials (RCTs) published in any language. The review included participants who were children (aged 4-18 years) diagnosed with a FAPD defined by the Rome or similar criteria. Psychosocial interventions included cognitive behavioural therapy (CBT), yoga, hypnotherapy, educational support, gut-directed hypnotherapy, guided imagery, and relaxation. The comparators were no intervention or any control. The primary outcomes were treatment success, pain frequency, pain intensity, and withdrawal owing to adverse event.
Two independent reviewers selected trials for inclusion, evaluated risk of bias and extracted data. Any disagreements were resolved by consensus discussions or by a third reviewer. Trial risk of bias was evaluated using the Cochrane risk of bias tool and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Meta-analysis was used to pool the included trials to calculate risk ratio (RR) with corresponding 95% Confidence Intervals (CIs) for dichotomous data.
33 trials (2657 children) were included in the review. Participants had a mean [range] age of 12 [7-17] years and were predominately female (67.3%). CBT was the most investigated intervention compared to no intervention (n=12), followed by yoga (n=3) and hypnotherapy (n=2). The remaining trials (n=16) compared a psychosocial intervention with another active intervention.
Compared to no intervention, there was moderate certainty evidence that CBT was associated with higher treatment success (RR 2.37 (95%CI 1.30 to 4.34; number needed to treat [NNT] = 5; 6 trials; 324 participants); low certainty evidence that there may be no difference in treatment success with yoga (RR 1.09 (95%CI 0.58 to 2.08; 2 trials; 99 participants); and low certainty evidence that hypnotherapy may lead to higher treatment success (RR 2.86 (95% CI 1.19 to 6.83; NNT=5; 2 trials; 91 participants).
CBT and hypnotherapy were associated with higher treatment success compared to no intervention for the management of FAPD, whereas yoga was not. CBT and hypnotherapy may be suitable treatment options for the management of FAPDs in childhood.
Gordon M, Sinopoulou V, Tabbers M, et al. Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2022. 1;176(6):560-568. doi: 10.1001/jamapediatrics.2022.0313.