What are the treatments of functional abdominal pain?
There is no specific medical treatment for functional abdominal pain helpful in all children. The treatment should be individualized on case to case basis. There are several types of treatment options available. You are encouraged to discuss with your child’s physician different treatment options and find one that works best with your child’s lifestyle and family beliefs.
It is important to build an ongoing relationship with the physician. Families should be prepared to visit or contact the physician on more than one occasion. The practitioner may want to reassess the progress and even change strategies if he or she considers it appropriate.
The goal of the treatment is not necessarily to eliminate the pain but to decrease it to a point where life can be enjoyable and the child can function without interference. Eliminating the pain should be a desirable long term goal, but not necessarily the goal of the initial phase of the treatment. Pain may not improve immediately. Decreases in pain intensity or frequency should be seen as a positive sign.
Children are encouraged to continue with their daily normal activities despite of the pain. It is important to remember that this is a benign condition with good outcome. With the ongoing treatment, the child should be able to resume normal life like any other child of their age without pain interference. Treatment may be prolonged and at times pain may recur. However, overall there should be a progressive improvement in pain control. If not, the management approach should be reassessed.
It is important to validate the child’s pain. Do not think that it is “all in their head.” Despite their pain, children should be encouraged to go back to the school and resume the routine activities.
You should address to the physician yours and your child’s concerns and fears. If you have identified any emotional stressors, share your thoughts with the doctor. The physician may provide strategies to help you and your child to deal with the episodes of pain. He or she may even refer the child to a specialist to help him or her deal with the pain.
Remember that the effectiveness of the treatment is based on the combined efforts of the physician, the patient, and the family. It is important for the child to be an active participant in the treatment plan and understand that he or she will be required to help in his or her own improvement.
Treatment may include diet and lifestyle changes, medicines, and complementary or alternative therapies.
Dietary changes – Although there is little scientific evidence to support the effectiveness of the dietary modifications to improve abdominal pain, some children may benefit of dietary changes. These are recommended on a case-by-case basis. For children with lactose intolerance, eliminating lactose (a natural sugar found in milk and other dairy products) from the diet may be of benefit. If lactose intolerance is suspected, some physicians may recommend testing for this condition or recommend a trial elimination of dairy products. If the elimination of dairy products does not result in improvement of the pain or other gastrointestinal symptoms this is not a likely cause of the pain. Trial should be limited to only a few weeks. That is enough time to realize if there is a relation between diet and symptoms.
Limiting the diet excessively may result in malnutrition and failure to grow. If prolonged dietary treatment is recommended it may be a good idea to obtain guidance and advice from a nutrition specialist, such as a registered dietician or physician.
Although there is no evidence that fiber is beneficial in the treatment of functional abdominal pain in children, an appropriate dose of fiber in the daily diet is recommended. A trial of high fiber diet may improve pain symptoms in some children but may also worsen it in others. Fiber is available in fruits and vegetables (unpeeled fruits, raw tomatoes, sweet potatoes, green leafy vegetables, fruit juices) that can be included in the regular diet. Other ways of increasing a child’s consumption of fiber is offering bran cereals, shredded wheat, graham crackers, or whole wheat bread. For children, minimum daily fiber intake (in grams) should equal the child’s age (in years) plus five grams.
It may be helpful to avoid spicy foods, caffeine, and carbonated drinks. Some children with abdominal pain who also experience “gas” may improve by eating food slowly and by avoiding gas forming food such as beans, cabbage, onions, celery, and raisins. Sugar free candy and sugar free chewing gum sweetened with sorbitol should be avoided if those result in pain. Sorbitol cannot be properly digested and can cause bloating and diarrhea.
Lifestyle changes and family support – Children should be encouraged to return to school. Children in school get distracted and focused on other things than their pain. Not attending school may cause problems with school grades and socialization, which may result in further anxiety to the child. It is important to help your child learn to deal with pain and to minimize the disruption it can cause to his or her life. A supportive and understanding environment at home and school is important to keep the child physically and mentally healthy.
Children should be allowed to use school restrooms as needed. It is helpful to communicate the child’s condition to the school nurse and teachers. In this way, they will be aware and will be prepared to react when the child has abdominal pain and will not resort to send the child home every time there is a complain of abdominal pain.
Medicines and complementary or alternative therapies – Treatment of functional abdominal pain in children is mostly based on experience and adult studies. But, there are studies which support that some medications may help improve pain in children. Commonly used medications include antispasmodics, acid-suppressants, laxatives, anti-diarrheals, or medications that help adjust the pain sensation. Some children may be prescribed a combination of those medications.
Antidepressants – If your doctor prescribes an antidepressant it may not indicate that your child is depressed. These medications may be used to treat pain, not to treat depression. In some children low doses of tricyclic antidepressants can be used to adjust the pain perception. To treat pain they are used in a much lower dose than is used to treat depression. Parents should expect a discussion on the benefits and side effects of these medications.
Herbal therapies – Studies have shown that enteric coated peppermint oil is sometimes beneficial in the treatment of functional abdominal pain in children.
Probiotics – There is not enough evidence on the effectiveness of probiotics in the treatment of functional abdominal pain in children. Probiotics seem to be helpful in children complaining of bloating or abdominal distention.
Behavioral therapies – Cognitive behavioral therapy, guided imagery, hypnosis, and biofeedback help to reduce anxiety and stress. Functional abdominal pain is not a psychological problem but may benefit from psychological intervention in some cases. Cognitive behavioral therapy increases the child’s understanding of pain and helps the child to deal with the pain in novel ways. There is evidence that cognitive behavioral therapy is beneficial in adults and children if applied by a psychologist with experience and deep understanding of the mechanisms involved in functional abdominal pain.
Relaxation techniques – Brief muscle relaxation techniques may be beneficial in some patients. These techniques may provide the child with new ways of dealing with the pain. Anxiety and stress may also be reduced by using these techniques. Relaxation techniques may be used alone or in combination with other techniques.
Guided imagery – This treatment uses the suggestion and the power of the child’s mind to improve pain and wellbeing. There is evidence that it may be beneficial even in children that failed drug therapy.
Hypnotherapy – This is a valuable technique that has been proven to be highly beneficial in children with functional abdominal pain. Studies have shown that up to 85% of children accomplished total remission of symptoms in one year. The results are seen much earlier but it is significant that almost all patients in a study on hypnotherapy were pain free even 9 months after the treatment was suspended. This implies that the results are durable. Hypnotherapy sessions are generally done 2–4 times a month. Frequency and time of treatment may vary for individual patient. In general, patients accomplish good results in only a few sessions. Although it is not necessary, it could be useful to undergo hypnotherapy conducted by a psychologist who can evaluate if any psychological treatments should be recommended. It is recommended to undergo therapy with a licensed hypnotist with experience in the management of functional conditions.
What are the effects of the functional abdominal pain in the long term?
While the prognosis is generally good, in some persons functional abdominal pain will be a long-lasting condition. Some will have pain conditions, such as irritable bowel syndrome, as adults. However, one-third to one-half of children will get better with no intervention within 2–6 weeks after they are diagnosed. Other children may obtain a complete resolution of the pain with treatment.
Source: Adapted from IFFGD Publication Functional Abdominal Pain in Children and Adolescents by Miguel Saps, MD, University of Miami Hospital, Miami, FL.
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