The Cochrane Library and the Treatment of Chronic Abdominal Pain in Children and Adolescents: An Overview of Reviews
Authors: Foisy Michelle , Ali Samina , Geist Rose , Weinstein Michael , Michail Sonia , Thakkar Kalpesh 
Published: July 2011

Background

Chronic abdominal pain is a common, disabling and longstanding condition for children and their families that often involves lengthy treatment plans and regular re‐evaluation. Chronic abdominal pain refers to both organic and functional pain, although for the majority of children and adolescents, the pain is functional in origin. Clinicians often feel pressure from parents to provide some type of treatment, and a large number of interventions are used in an attempt to decrease associated symptoms and functional impairment. Substantial variation in the treatment of childhood chronic abdominal pain currently exists.

Objectives

This overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the efficacy and safety of various dietary, pharmacological and psychological interventions for the treatment of chronic abdominal pain in children and adolescents.

Methods

Issue 5, 2011 of the CDSR was searched for all reviews examining pharmacologic or non‐pharmacologic treatments for chronic abdominal pain in children and adolescents. All relevant systematic reviews were included, and data were extracted, compiled into tables and synthesized using qualitative and quantitative methods.

Main Results

Five reviews containing 19 pediatric trials and 777 participants were included in this overview. In one small trial (n = 64), post‐treatment pain scores and school absences decreased significantly when children received combined cognitive behavioural therapy (CBT), biofeedback, parental support and fibre compared to fibre alone. In two small trials (n = 47; n = 69), internet CBT compared to standard pediatric care significantly decreased pain at follow‐up and family CBT versus standard care significantly decreased school absences. In adolescents, two small trials (n = 33; n = 90) found that treatment with amitriptyline compared to placebo had a limited effect on some, but not all, measured outcomes. Data on adverse events were generally lacking for all dietary and psychological interventions; for pharmacological interventions, no differences in adverse events were reported, with only minor adverse events (i.e. fatigue, rash, headache) reported.

Authors' Conclusions

The successful management of chronic abdominal pain requires a comprehensive, multifaceted approach. The current evidence, albeit limited, suggests that CBT may be effective and that refocusing the patient and family on coping strategies as well as emphasizing normal childhood functioning can have positive results. As such, psychological treatments such as CBT look promising for the treatment of childhood chronic abdominal pain. If pharmacological interventions are considered, current evidence may support a trial of amitriptyline for adolescents with irritable bowel syndrome. However, both of these conclusions are based on a small number of short‐duration trials that are at high or unclear risk of bias. Overall, conclusive evidence is lacking to support dietary, pharmacological and psychological interventions. Future high‐quality, adequately powered trials are eagerly awaited. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration