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Treating Pediatric Stomach Pain by Targeting Anxiety

Young girl with her arms rapped around her body.

When children or teenagers complain of recurring abdominal pain, one effective treatment option uses cognitive behavioral therapy to target both the discomfort and the anxiety that may be triggering it, says a Michigan State University researcher.

“Our previous research has shown anxiety is very common in kids with functional abdominal pain,” said Natoshia Cunningham, an assistant professor in the Department of Family Medicine in the MSU College of Human Medicine. “We see it in about 40% to 50% of cases.”

Cunningham’s research was published on Oct. 29 in the Journal of Pediatrics.

Headshot of Natasha Cunningham, she has dirty blond hair with a blue and green striped shirt.

Natasha Cunningham

“Kids with increased anxiety may experience more pain and have greater impairment in physical and daily functioning due to their pain,” Cunningham said. “Such kids may experience things like school absences, poorer academic performance, social difficulties and difficulty concentrating due to their pain symptoms.”

Cunningham, a pediatric psychologist who specializes in developing and testing personalized psychological treatments for kids with chronic health conditions involving pain, explains the connection between anxiety and pain. “The pain is very real and anxiety can make it worse,” she said. “The worries may increase pain symptoms and lead to the avoidance of certain activities, which can result in a vicious cycle of pain and disability. That is why it is important to use a tailored psychological treatment approach to manage both pain and anxiety.”

Young patients in the current study were diagnosed with functional abdominal pain by a pediatric gastroenterologist. The sample included primarily Caucasian females ranging from 9 to 14 years of age who complained of debilitating, persistent belly pain. All participating youth received some psychoeducation and relaxation training as part of their medical care, but the majority failed to respond to this initial dose of treatment.

“Some kids may get better on their own; however, a significant portion can go on to experience symptoms over time and may also develop other pain conditions and mental health problems,” Cunningham said. “Anxiety may be a risk factor for persistent symptoms. We wanted to arm patients with tools to help them cope with their pain and worries to stop functional abdominal pain from becoming a long-term problem.”

So, Cunningham created and tested the Aim to Decrease Anxiety and Pain Treatment, or ADAPT, program with funding from the National Institutes of Health, American Pain Society and Cincinnati Children’s Hospital Medical Center.

“One of the goals of the ADAPT program is to give kids the tools through cognitive behavioral therapy, or CBT, an evidence-based approach to help them deal with their emotions and manage their pain,” she said. “We teach them a blend of cognitive and behavioral strategies to cope with pain and worries.”

For kids also experiencing anxiety, additional CBT skills included “detective thinking” to challenge worrisome thoughts, gradual exposure to fearful situations and social skills training. “We taught the kids assertiveness training,” Cunningham expanded. “This skill helped them ask for things they need in the classroom, like time to take some deep breaths and how to deal with bullies.”

The results of this pilot randomized clinical trial revealed that pain and anxiety levels decreased for patients who completed ADAPT plus their usual medical care, compared to those who only completed medical treatment as usual.

Overall, using CBT to support patient mental health made a significant impact on their well-being and functioning. The program was tested in younger children and teens, the majority of whom were female. Cunningham suspects the program may also be beneficial for older teens as well.

“Girls are more likely to experience abdominal pain and anxiety and are also more prone to develop depression as they go through adolescence,” she said. “It is our hope that if we can teach them these coping strategies early perhaps we can promote their resilience as they grow older.”

Cunningham plans to study how ADAPT impacts the brain in youth with functional abdominal pain in partnership with collaborators at Spectrum Health/Helen DeVos Children’s Hospital. She also hopes to expand ADAPT program in Michigan, possibly in collaboration with primary care physicians or community groups. In response to the COVID-19 pandemic, future iterations of ADAPT can be delivered entirely virtually, and she also hopes to directly target COVID-19 related distress as part of the ADAPT program.

Emilie Lorditch via MSU Today.

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