%0 Journal Article %J JAMA Pediatr %D 2013 %T Twelve-month follow-up of cognitive behavioral therapy for children with functional abdominal pain. %A Levy, Rona L %A Langer, Shelby L %A Walker, Lynn S %A Romano, Joan M %A Christie, Dennis L %A Youssef, Nader %A DuPen, Melissa M %A Ballard, Sheri A %A Labus, Jennifer %A Welsh, Ericka %A Feld, Lauren D %A Whitehead, William E %K Abdominal Pain %K Adaptation, Psychological %K Adolescent %K Adult %K Child %K Cognitive Therapy %K Female %K Follow-Up Studies %K Gastrointestinal Diseases %K Humans %K Illness Behavior %K Linear Models %K Male %K Middle Aged %K Pain Measurement %K Parent-Child Relations %K Prospective Studies %K Treatment Outcome %X

OBJECTIVE: To determine whether a brief intervention for children with functional abdominal pain and their parents' responses to their child's pain resulted in improved coping 12 months later.

DESIGN: Prospective, randomized, longitudinal study.

SETTING: Families were recruited during a 4-year period in Seattle, Washington, and Morristown, New Jersey.

PARTICIPANTS: Two hundred children with persistent functional abdominal pain and their parents.

INTERVENTIONS: A 3-session social learning and cognitive behavioral therapy intervention or an education and support intervention.

MAIN OUTCOME MEASURES: Child symptoms and pain-coping responses were monitored using standard instruments, as was parental response to child pain behavior. Data were collected at baseline and after treatment (1 week and 3, 6, and 12 months after treatment). This article reports the 12-month data.

RESULTS: Relative to children in the education and support group, children in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month follow-up decreases in gastrointestinal symptom severity (estimated mean difference, -0.36; 95% CI, -0.63 to -0.01) and greater improvements in pain-coping responses (estimated mean difference, 0.61; 95% CI, 0.26 to 1.02). Relative to parents in the education and support group, parents in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month decreases in solicitous responses to their child's symptoms (estimated mean difference, -0.22; 95% CI, -0.42 to -0.03) and greater decreases in maladaptive beliefs regarding their child's pain (estimated mean difference, -0.36; 95% CI, -0.59 to -0.13).

CONCLUSIONS: Results suggest long-term efficacy of a brief intervention to reduce parental solicitousness and increase coping skills. This strategy may be a viable alternative for children with functional abdominal pain.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00494260.

%B JAMA Pediatr %V 167 %P 178-84 %8 2013 Feb %G eng %N 2 %R 10.1001/2013.jamapediatrics.282 %0 Journal Article %J BMC Complement Altern Med %D 2008 %T Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO. %A van Tilburg, Miranda A L %A Palsson, Olafur S %A Levy, Rona L %A Feld, Andrew D %A Turner, Marsha J %A Drossman, Douglas A %A Whitehead, William E %K Abdominal Pain %K Adult %K Complementary Therapies %K Constipation %K Cost-Benefit Analysis %K Delivery of Health Care, Integrated %K Diarrhea %K Female %K Ginger %K Health Maintenance Organizations %K Humans %K Irritable Bowel Syndrome %K Male %K Massage %K Middle Aged %K Patient Satisfaction %K Phytotherapy %K Professional-Patient Relations %K Prospective Studies %K Surveys and Questionnaires %K United States %K Yoga %X

BACKGROUND: Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain.

METHODS: 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims.

RESULTS: CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription medication were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice.

CONCLUSION: CAM is used by one-third of FBD patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

%B BMC Complement Altern Med %V 8 %P 46 %8 2008 %G eng %R 10.1186/1472-6882-8-46