Skip to main content

Advertisement

Log in

Evaluation of a Cognitive–Behavioral Pain Management Program for Children with Chronic Abdominal Pain: A Randomized Controlled Study

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Chronic abdominal pain (CAP) in childhood is widely prevalent and has adverse effects on mental health and quality of life. Earlier research emphasized the positive effects of psychological intervention on pain symptoms. This study describes the results of a cognitive–behavioral pain management program for children with CAP. The newly developed cognitive–behavioral group program, “Stop the pain with Happy-Pingu,” includes six sessions for the children and one meeting for the parents.

Purpose

We hypothesized that the training would significantly reduce pain symptoms (frequency, duration, intensity, and pain-related impairment) and increase health-related quality of life compared to wait-list controls, with improvement seen both at the end of treatment and at a 3-month follow-up.

Method

In all, 29 children were randomized into two groups: 15 in the intervention group (IG) and 14 as the wait-list controls (WLC). An intent-to-treat analysis was performed using two-factorial multivariate analyses of variance with repeated measures.

Results

Children in the IG experienced both a reduction in pain (primary outcome) and an improvement in health-related quality of life (secondary outcome) as compared to the WLC. The effect sizes ranged from medium to high.

Conclusion

Cognitive–behavioral methods seem to be appropriate for treating children with CAP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Apley J, Naish N. Recurrent abdominal pain: a field study of 1000 school children. Arch Dis Child. 1958;33:165.

    Article  PubMed  CAS  Google Scholar 

  2. Berger MY, Gieteling MJ, Benninga MA. Chronic abdominal pain (clinical review). BMJ. 2007;334:997–02.

    Google Scholar 

  3. Bortz J, Döring N. Forschungsmethoden und Evaluation für Human- und Sozialwissenschaftler. 3. überarb. Auflage. Heidelberg: Springer; 2005.

  4. Campo JV, Di Lorenzo C, Chiappetta L, Bridge J, Colborn DK, Gartner C, et al. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it? Pediatrics. 2001;108:e1–7.

    Article  PubMed  CAS  Google Scholar 

  5. Chitkara DK, Rawat DJ, Talley NJ. The epidemiology of childhood recurrent abdominal pain in western countries: a systematic review. Am J Gastroenterol. 2005;100:1868–75.

    Article  PubMed  Google Scholar 

  6. Cohen J. Statistical power analysis for the behavioral science. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988.

    Google Scholar 

  7. Cohen LL, Lemanek K, Blount RL, Dahlquist LM, Lim CS, Palermo TM, et al. Evidence-based assessment of pediatric pain. J Pediatr Psychol. 2008;33:939–55.

    Article  PubMed  Google Scholar 

  8. Denecke H, Glier B, Klinger R, Kröner-Herwig B, Nilges P, Redegeld M, et al. Qualitätssicherung in der Schmerztherapie chronischen Schmerzes. X. Instrumente zur Erfassung von Schmerz bei Kindern. Der Schmerz. 1997;11:120–5.

    Article  PubMed  CAS  Google Scholar 

  9. Denecke H, Kröner-Herwig B. Kopfschmerztherapie mit Kindern und Jugendlichen. Göttingen: Hogrefe; 2000.

    Google Scholar 

  10. Duarte MA, Penna FJ, Andrade EMG, Cancela CSP, Neto JCA, Barbosa TF. Treatment of nonorganic recurrent abdominal pain: cognitive–behavioral family intervention. J Pediatr Gastroenterol Nutr. 2006;43:59–64.

    Article  PubMed  Google Scholar 

  11. Eccleston C, Morley S, Williams A, Yorke L, Mastroyannopulou K. Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief. Pain. 2002;99:157–65.

    Article  PubMed  Google Scholar 

  12. Ellert U, Neuhauser H, Roth-Isigkeit A. Schmerzen bei Kindern und Jugendlichen in Deutschland: Prävalenz und Inanspruchnahme medizinischer Leistungen. Ergebnisse der Kinder- und Jugendgesundheitssurveys (KIGGS). Bundesgesundheitsbl—Gesunheitsforsch—Gesundheitsschutz. 2007; 50: 711–17.

  13. Field A. Discovering statistics using SPSS. 3rd ed. London: Sage; 2009.

    Google Scholar 

  14. Greenhouse SW, Geisser S. On methods in the analysis of profile data. Psychometrica. 1959;24:95–112.

    Article  Google Scholar 

  15. Hicks CL, von Baeyer CL, McGarth PJ. Online psychological treatment for pediatric recurrent pain: a randomized evaluation. J Pediatr Psychol. 2006;31:724–36.

    Article  PubMed  Google Scholar 

  16. Hotopf M, Carr S, Mayou R, Wadsworth M, Wessely S. Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study. BMJ. 1998;316:1196–200.

    Article  PubMed  CAS  Google Scholar 

  17. Humphrey PA, Gevirtz RN. Treatment of recurrent abdominal pain: components analysis of four treatment protocols. Journal of Pediatr Gastroenterol Nutr. 2000;31:47–51.

    Article  Google Scholar 

  18. Jacobs B. Einige Berechnungsmöglichkeiten von Effektstärken. http:/www.phil.uni-sb.de/~jakobs/seminar/vpl/bedeutung/effektstaerketool.htm. Accessed 20 Sep 2010.

  19. Karlson CW, Rapoff MA. Attrition in randomized controlled trials for pediatric chronic conditions. J Pediatr Psychol. 2009;34:782–93.

    Article  PubMed  Google Scholar 

  20. Konijnenberg AY, Uiterwaal CS, Kimpen JLL, van der Hoeven J, Buitelaar JK, de Graeff-Meeder ER. Children with unexplained chronic pain: substantial impairment in everyday life. Arch Dis Child. 2005;9:680–6.

    Article  Google Scholar 

  21. Levy RL, Langer SL, Walker LS, Romano JM, Christie DL, Youssef N, et al. Cognitive–behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. Am J Gastroenterol. 2010;105:946–56.

    Article  PubMed  Google Scholar 

  22. Magista A, De Canio A, Chiarelli T, Leone G, Fico S, Cavallo L, et al. Comparison of Rome II versus Rome III in classifying children with abdominal pain. Dig Liver Dis. 2006;38:A116.

    Article  Google Scholar 

  23. Palermo TM, Eccleston C, Lewandowski AS, Williams AC, Morley S. Randomized controlled trials of psychological therapies of chronic pain in children and adolescents: a updated meta-analytic review. Pain. 2010;148:387–97.

    Article  PubMed  Google Scholar 

  24. Palermo TM, Wilson AC, Peters M, Lewandowski A, Somhegyi H. Randomized controlled trial of an internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain. Pain. 2009;146:205–13.

    Article  PubMed  Google Scholar 

  25. Ravens-Sieberer U, Bullinger M. KINDLR. Manual: Fragebogen zur Erfassung der gesundheitsbezogenen Lebensqualität bei Kindern und Jugendlichen. Revidierte Form; 2000.

    Google Scholar 

  26. Robins PM, Smith SM, Glutting JJ, Bishop CT. A randomized controlled trial of a cognitive–behavioral family intervention for pediatric recurrent abdominal pain. J Pediatr Psychol. 2005;30:397–408.

    Article  PubMed  Google Scholar 

  27. Sanders MR, Shepherd RW, Cleghorn G, Woolford H. The treatment of abdominal pain in children: a controlled comparison of cognitive behavioral family intervention and standard pediatric care. J Consult Clin Psychol. 1994;62:306–14.

    Article  PubMed  CAS  Google Scholar 

  28. Subcommittee on chronic abdominal pain. Clinical report: chronic abdominal pain in children. Pediatrics. 2005;115:812–5.

    Article  Google Scholar 

  29. Schlarb A, Gulewitsch MD, Bock I, Enck P, Hautzinger M. Recurrent abdominal pain in children and adolescents—a survey among paediatricians. GMS Psycho-Social-Medicine. 2011;8:1–7.

    Google Scholar 

  30. Unnewehr S, Schneider S, Margraf J. Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS). Heidelberg: Springer; 1998.

    Google Scholar 

  31. van Gessel H, Gaßmann J, Kröner-Herwig B. Children in pain: recurrent back pain, abdominal pain, and headache in children and adolescents in a four-year-period. J Pediatr. 2011;158:977–83.

    Article  PubMed  Google Scholar 

  32. Varni JW, Lane MM, Burwinkle TM, Fontaine EN, Youseff NN, Schwimmer JB, et al. Health-related quality of life in pediatric patients with irritable bowel syndrome: a comparative analysis. J Dev Behav Pediatr. 2006;27:451–8.

    Article  PubMed  Google Scholar 

  33. Varni JW, Limbers CA, Burwinkle TM. Impaired health-related quality of life in children and adolescents wih chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severeties utilizing the PedsQL™ Version 4.0 generic core scales. Health Qual Life Outcomes. 2007;5:43–58.

    Article  PubMed  Google Scholar 

  34. Varni JW, Seid M, Kurtin PS. PedsQL™ version 4.0: reliability and validity of the pediatric quality of life inventory™ version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39:800–12.

    Article  PubMed  CAS  Google Scholar 

  35. Walker LS, Garber J, van Slyke DA, Greene JW. Long-term health outcomes in patients with recurrent abdominal pain. J Pediatr Psychol. 1995;20:233–45.

    Article  PubMed  CAS  Google Scholar 

  36. Warschburger P. Psychologie der atopischen Dermatitis im Kindes-und Jungendalter. München: Quintessenz; 1996.

    Google Scholar 

  37. Warschburger P, Groß M. “Stopp den Schmerz”—Ein kognitiv-behaviorales Behandlungsprogramm für Kinder mit Bauchschmerzen—Erste Ergebnisse einer Pilotstudie. Verhaltenstherapie. 2008;18:162–7.

    Article  Google Scholar 

  38. Wittchen HU, Perkonigg A, Lachner G, Nelson B. Early development stages of psychopathology study (EDSP): objectives and design. Eur Addict Res. 1998;4:18–27.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This work was supported by a grant to M. G. of Potsdam Graduate School.

Conflict of interest

There are no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Petra Warschburger.

Additional information

Trial registration Current Controlled Trials ISRCTN 69830258

Rights and permissions

Reprints and permissions

About this article

Cite this article

Groß, M., Warschburger, P. Evaluation of a Cognitive–Behavioral Pain Management Program for Children with Chronic Abdominal Pain: A Randomized Controlled Study. Int.J. Behav. Med. 20, 434–443 (2013). https://doi.org/10.1007/s12529-012-9228-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-012-9228-3

Keywords

Navigation