<i>The Cochrane Library</i> and the Treatment of Chronic Abdominal Pain in Children and Adolescents: An Overview of Reviews
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.006 |
| Bibliometrics | 0.017 | 0.026 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".