Cognitive-Behavioral Therapy May Reduce Pain Associated With Functional Abdominal Pain Among Children

Investigators compared the efficacy of cognitive-behavioral therapy vs an attention control for reducing abdominal pain in children with functional abdominal pain.

For children with functional abdominal pain (FAP), cognitive-behavioral therapy (CBT) was more effective at reducing pain duration and intensity than an attention control over time. These findings, from a prospective, multicenter, randomized trial, were published in the American Journal of Gastroenterology.

Children (N=127) with FAP were recruited at 6 secondary and tertiary outpatient clinics in Germany between 2014 and 2016. Participants were randomly assigned in a 1:1 ratio to receive CBT (n=63) or attention control (n=64). Both conditions consisted of 6 weekly 90-minute group sessions with a trainer, two 50-minute parent sessions, and a daily pain diary. The CBT program focused on enhancing the child’s self-management of pain by practicing coping skills. All children were assessed for symptoms of pain up to 12 months.

Study participants were aged mean 9.83±1.72 years, 43.3% were boys, had an average age at onset of FAP of 6.90±2.76 years, 81.1% were in the middle socioeconomic class, and the children had missed school 3.10±6.81 days during the past 4 weeks.

Adherence to treatment was 88.96% for the CBT group and 84.25% for control participants among the children and 91.38% for the CBT group and 97% for control participants among the parents.

Compared with the control group, children were significantly more satisfied with treatment in the CBT group (mean difference [MD], 8.27; 95% CI, 2.17-14.37) and had higher treatment success (MD, 13.80; 95% CI, 4.93-22.68).

No significant differences in pain intensity (mean reduction, 49.04%; 95% CI, -19.98% to 78.36%; P =.122), pain duration (mean reduction, 51.35%; 95% CI, -18.16% to 79.97%; P =.110), or number of episodes (mean reduction, -7.46%; 95% CI, -19.48% to 43.43%; P =.625) were observed in the primary analysis.

In the longitudinal time trend analysis, significant differences were observed for pain intensity (mean reduction, 40.91%; 95% CI, 2.71%-64.12%; P =.038), favoring CBT. At 12 months, CBT was associated with changes in pain disability (mean reduction, 0.53; 95% CI, 0.22-0.85; P =.001), passive coping (mean reduction, -0.03; 95% CI, -0.05 to -0.01; P =.006), generic quality of life reported by parents (mean reduction, -0.37; 95% CI, -0.69 to -0.06; P =.020), pain catastrophizing (mean reduction, 0.56; 95% CI, 0.07-1.05; P =.025), pain duration (mean reduction, 43.6%; 95% CI, 6.2%-66.1%; P =.027), and abdominal quality of life reported by parents (mean reduction, -0.50; 95% CI, -0.94 to -0.05; P =.027).

This study is not without bias, as there was some evidence that girls responded better to the control condition than boys, which may have contributed to their positive outcomes.

These data indicated that in the long term, CBT was more effective at reducing pain associated with FAP among the pediatric population compared with an attention control.


Warschburger P, Calvano C, Becker S, et al. Do children with functional abdominal pain benefit more from a pain-specific cognitive-behavioral intervention than from an unspecific attention control intervention? results of a randomized controlled trial. Am J Gastroenterol. 2021;116(6):1322-1335. doi:10.14309/ajg.0000000000001191