Cognitive behavioral therapy (CBT) and hypnotherapy should be considered viable treatments for children diagnosed with functional abdominal pain disorders (FAPDs), according to study findings published in JAMA Pediatrics.
Using a systematic review and meta-analysis, researchers identified 33 randomized controlled trials during a search through PubMed, Embase, the Cochrane Library, Medline, and PscyINFO, from the inceptions of these databases until August 2021. Researchers also searched unpublished and ongoing clinical trials on ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and the metaRegister of Controlled Trials.
Only trials that compared psychosocial interventions with other interventions or placebo for children with FAPDs between the ages of 4 and 18 were included for the study. Primary outcomes of interest included pain frequency, pain intensity, or withdrawal due to adverse events. Secondary outcomes included anxiety/depression, quality of life, defecation patterns, relief, attendance or performance at school, and the occurrence of serious adverse events.
In the 33 included trials, 2622 children received psychosocial treatments, including CBT, yoga, distinct types of hypnotherapies (including gut-directed hypnotherapy), guided imagery, visceral osteopathy, biofeedback, electrical neurostimulation, and written self-disclosure. The investigators rated all studies as having high risk of bias, except one.
After adjusting for risk of bias, moderate certainty evidence supported that CBT lowered pain frequency (risk ratio [RR], -0.36; 95% CI, -0.63 to -0.09), lowered pain intensity (RR, -0.58; 95% CI, -0.83 to -0.32), and had higher success rates of treatment (RR, 2.37; 95% CI, 1.30-4.34) compared with no intervention in children with FAPDs.
Low certainty evidence supported that hypnotherapy resulted in higher treatment success (RR, 2.86; 95% CI, 1.19-6.83) compared with no intervention. Low certainty evidence suggested that yoga had similar outcomes as compared with no intervention (RR, 1.09; 95% CI, 0.58-2.08). No other evidence-based conclusions could be drawn for the other psychosocial interventions due to high imprecision and risk of bias.
“Results of this systematic review and meta-analysis suggest that CBT and hypnotherapy should be considered as a treatment for FAPDs in childhood,” the study authors wrote. “These news findings should be considered by guideline committees internationally.”
Study limitations included the downgrading of evidence used in this study due to risk of bias, the open-label design of many of the included studies, which could have influenced the placebo effect, small sample sizes, and poor data reporting, particularly of lack of variance and standard deviation.
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. Published online April 11, 2022. doi:10.1001/jamapediatrics.2022.0313