A New Biobehavioral Treatment Approach for Recurrent Abdominal Pain

Abstract

Purpose: Childhood recurrent abdominal pain (RAP) has been hypothesized to be associated with a deficit in autonomic nervous system (ANS) recovery to stress and an enhanced subjective response to pain. Respiratory sinus arrhythmia, which is positively correlated with heart rate variability, has been shown to be an indicator of ANS functioning. Therapeutic heart rate variability biofeedback (BF) attempts to achieve behavior modification toward pain and has been used in the treatment of RAP. A decrease in pain frequency and intensity along with an improvement in ANS functioning would serve as valid endpoints, marking efficacy of this therapeutic intervention in RAP. The objective of this study is to determine pain intensity, pain frequency, and ANS functioning of children with RAP after completing BF. Methods: Children diagnosed with RAP were referred for BF by pediatric gastroenterologists. The children were seen by doctoral interns for an average of 6 weekly sessions. The data was collected prior to BF treatment and post treatment. Outcome measures used included: pain intensity (visual analogue scale, 1 to 10), pain frequency (episodes per week), and ANS functioning as measured by peak to valley differences in respiratory sinus arrhythmia (RSA). Results: 64 children (70% female, aged 7 to 18 years) had been diagnosed with RAP and undergone BF treatments (6 sessions, range 1–12). Pain intensity and frequency were significantly reduced. RSA was significantly increased (see table).Table: Pain Levels and RSAConclusions: In this cohort of children with RAP who were treated with BF, there was a marked decrease in pain intensity and frequency after completing BF in a pediatric medical setting. BF should be considered as a cost effective first line therapy for childhood RAP. Long-term studies need to be performed to see if this positive outcome effect persists into adulthood.