Recurrent abdominal pain in children: valid CBTs

Paris, France– A meta-analysis of trials on recurrent functional abdominal pain in children and adolescents concluded in favor of cognitive-behavioral therapy and hypnosis for analgesic purposes.[1].This publication confirms the literary data as well as the practices, as explained by. Dr. Mark BelaichThis article is about gastro-pediatrician at Robert Debre Hospital (Paris).

Pediatric Functional Bowel Disorder

According to current standards (ROME IV)[2]), Functional bowel disorders in older children and adolescents include cyclical vomiting syndrome, constipation, functional nausea, and the group consisting of “effective abdominal pain” where dyspeptic and irritable bowel syndrome coexist. , Abdominal migraine and recurrent pain.

Functional abdominal pain is common in children. Over 50% of new patient visits to pediatric gastroenterology clinics meet the criteria for one or more functional gastrointestinal disorders and functional abdominal pain for a large proportion of these clinics.[3].

“The first step in treatment is to isolate functional dyspepsia – epigastric pain that worsens when the baby is eating – from abdominal migraine or cyclic vomiting syndrome, which is treated like cephalologic migraine,” said Dr. Mark Belaich. Non-specific), a significant proportion of gastro-pediatric counseling. They can seriously affect the lives of children and their families; symptoms often extend to adults.

CBT reduces the frequency and severity of pain

A meta-analysis has just been published[1] On the interest of psychosocial interventions in recurrent functional abdominal pain in children.

Cognitive-behavioral therapy (CBT) is associated with improved treatment success and lower pain frequency and severity in the management of recurrent functional abdominal pain in children.

Cognitive-behavioral therapy (CBT) is associated with improved treatment success.

Based on this systematic review and meta-analysis of 33 randomized clinical trials involving 2622 children (median age 12 years (7-17 years); 67.3% females), the incidence of taking cognitive behavioral therapy involves:

  • Increased treatment success (n = 324 children; RR, 2.37; 95% CI 1.30-4.34; number required for treatment [NNT] = 5);

  • Low pain frequency (n = 446 children; RR, -0.36; 95% CI, -0.63 to -0.09);

  • Low pain intensity (n = 332 children; RR, -0.58; 95% CI, -0.83 to .30.32) without intervention;

  • As well as similar dropouts due to adverse events compared to any intervention.

Hypnotherapy may be associated with better results than any intervention.

Very real pain that should not be ignored

This publication does not raise concerns about the origin of the pain experienced by the child with irritable bowel syndrome or transit disorder (constipation, diarrhea or mixed) and especially pharmacologically which can be dealt with.

“On the other hand, in the case of this recurrent (or” non-specific “) abdominal pain, the absence of the therapeutic hook (in addition to the effective abdominal pain of the child” swallowing the air “) makes us helpless, underlines Mark Belaiche. However, the pain is very real and There is no question of neglect, it continues or even risks getting worse. “

In the case of this recurrent (or “non-specific”) abdominal pain, the absence of a therapeutic hook makes us helpless.
Dr. Mark Belaich

The mechanisms behind repeated abdominal pain are not fully understood. The basic theory suggests a dislocation of the brain-intestinal communication axis. The interaction and response of various genetic, physiological, psychological and environmental factors will thus affect the central nervous system and gastrointestinal motility.

In these so-called somatoform disorders, more than the symptoms, the cause (s) must be treated. These have been well described for about ten years and occur by genetics or over a specific terrain over time.

“A traumatic event, even decent, can cause functional abdominal pain in a child with visceral hypersensitivity,” the specialist continued.

A traumatic event, even decent, can trigger functional abdominal pain in a child with visceral hypersensitivity.
Dr. Mark Belaich

These events can take the form of gastroenteritis (post-infectious syndrome as evidenced by the eruption of functional abdominal pain after Covid-19), an allergic episode, physical shock, stress associated with a life event (moving, separation, even sexual abuse).

But in the end, care does not depend on the nature of the triggering event. If the notable drug could at least act as a placebo (it has actually been shown that, in this particular case, the placebo acted in one-third of cases), “positive polarity” has shown its interest in the “model of theory”. Ice cubes “(this (ice cube) is not a question of attacking the pain head but a question of setting up a suitable climate to reduce it (heat)).

Practicing “positive polarity”

“Positive polarity care means recognizing the pathology and its symptoms, prescribing prescription medications that will work in at least one-third of cases, and teaching the child as a parent that one of the best ways to combat his or her pain. It doesn’t have to suffer but invest in a painkiller therapeutic project, Dr. Belaich explains.

Children or adolescents can thus expect to break the vicious circle of pain, which is identical regardless of the nature of the trigger: when pain appears, fear increases, and so on. The idea is to reduce this risk of pain through scattering. But it is not only a passive confusion but also an active involvement, which comes from the person himself.

To date, this meta-analysis confirms that the sporadic phenomena that have demonstrated a certain efficacy are self-hypnosis, which requires therapeutic education, meditation, which often requires third parties, especially cognitive and behavioral therapy for children and pain. . Relief is adapted to the baby. “

The distracting phenomena that have demonstrated a certain effectiveness are cognitive and behavioral therapy, including self-hypnosis, meditation, and an analgesic goal.
Dr. Mark Belaich

TTC is a treatment for post-traumatic stress and recurrent abdominal pain is also a type of post-traumatic stress, which occurs in a specific area of ​​hypersensitivity and even in the case of minimal stress.

“This hypersensitivity must be understood as a quality and a skill, a curse that makes the pain unbearable,” he added. The child then needs to be taught that he alone is capable of breaking the vicious circle of pain, as soon as it manifests itself, through trans and meditation, or through the self. Distraction and CBT are taught during sessions using hypnosis, or adaptive tools. It is important to remove the “pain cover” so that the child can focus on himself.

While useful, this strategy is difficult to implement due to the lack of a formal or informal network of CBT specific knowledge or resources to assist children during available counseling time (45-50 minutes per session). (Psychologists, Algalists, Hypnotherapists, Caregivers trained in CBT …)

Consumer meditation applications can help (initiate analgesic meditation). Books for children and their parents by Professor Tu Anh Tran (Nimes University Hospital) combine meditation with experienced situations *.

“This publication highlighting the validity of CBTs and hypnosis in recurrent functional abdominal pain is important in the sense that it confirms the interest in these techniques and specifies what appears in the literature on the subject, Mark Belech points out, even if the level of evidence is not maximal. Due to the difficulty of conducting the study (identification of identical child profiles, etc.), the subjectivity of the pain assessment scale, structure or lack of professionals interested in it, as well as adequate placebo.

CBT and hypnosis verification in recurrent functional abdominal pain This publication is important.
Dr. Mark Belaich

* Professor Tran, head of the pediatrics department at Nimes University Hospital, has been using meditation for more than ten years to treat his young patients.

Chronic illness, pain, phobias, eating disorders, hyperactivity, anxiety, school difficulties, sleep disorders … In all these situations, meditation reduces stress and restores inner peace. Meditasoins – Small Meditation Theory Soccer Edition for Children’s Major Illness.

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