<i>The Cochrane Library</i> and the Treatment of Chronic Abdominal Pain in Children and Adolescents: An Overview of Reviews
Notice bibliographique
Résumé
Abstract Background Chronic abdominal pain is a common, disabling and longstanding condition for children and their families that often involves lengthy treatment plans and regular re‐evaluation. Chronic abdominal pain refers to both organic and functional pain, although for the majority of children and adolescents, the pain is functional in origin. Clinicians often feel pressure from parents to provide some type of treatment, and a large number of interventions are used in an attempt to decrease associated symptoms and functional impairment. Substantial variation in the treatment of childhood chronic abdominal pain currently exists. Objectives This overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the efficacy and safety of various dietary, pharmacological and psychological interventions for the treatment of chronic abdominal pain in children and adolescents. Methods Issue 5, 2011 of the CDSR was searched for all reviews examining pharmacologic or non‐pharmacologic treatments for chronic abdominal pain in children and adolescents. All relevant systematic reviews were included, and data were extracted, compiled into tables and synthesized using qualitative and quantitative methods. Main Results Five reviews containing 19 pediatric trials and 777 participants were included in this overview. In one small trial ( n = 64), post‐treatment pain scores and school absences decreased significantly when children received combined cognitive behavioural therapy (CBT), biofeedback, parental support and fibre compared to fibre alone. In two small trials ( n = 47; n = 69), internet CBT compared to standard pediatric care significantly decreased pain at follow‐up and family CBT versus standard care significantly decreased school absences. In adolescents, two small trials ( n = 33; n = 90) found that treatment with amitriptyline compared to placebo had a limited effect on some, but not all, measured outcomes. Data on adverse events were generally lacking for all dietary and psychological interventions; for pharmacological interventions, no differences in adverse events were reported, with only minor adverse events (i.e. fatigue, rash, headache) reported. Authors' Conclusions The successful management of chronic abdominal pain requires a comprehensive, multifaceted approach. The current evidence, albeit limited, suggests that CBT may be effective and that refocusing the patient and family on coping strategies as well as emphasizing normal childhood functioning can have positive results. As such, psychological treatments such as CBT look promising for the treatment of childhood chronic abdominal pain. If pharmacological interventions are considered, current evidence may support a trial of amitriptyline for adolescents with irritable bowel syndrome. However, both of these conclusions are based on a small number of short‐duration trials that are at high or unclear risk of bias. Overall, conclusive evidence is lacking to support dietary, pharmacological and psychological interventions. Future high‐quality, adequately powered trials are eagerly awaited. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».