Changes in Pain Cognitions Mediate Effects of Cognitive-Behavioral Treatment on Reductions in Symptoms and Disability in Children with Unexplained Abdominal Pain

Abstract

Purpose: A recent study by our group (Levy et al., 2010) demonstrated the effectiveness of a cognitive-behavioral intervention for parents and children aimed at reducing abdominal pain and disability in children with functional abdominal pain. However, the factors that mediated this change were unknown. The present study sought to determine whether the cognitive variables targeted by our intervention mediated intended outcomes. Methods: 200 children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions - a 3-session cognitive-behavioral (CBT) intervention targeting parents' reactions to their children's pain complaints and children's coping with symptoms, or a 3-session educational intervention that controlled for time and attention. Pain was assessed using the “current pain” item from the Faces Pain Scale-Revised (Hicks et al., 2001); GI Symptoms were assessed using the GI Symptom subscale of the Children's Somatization Inventory (Garber et al., 1991); and health-related disability was measured with the Functional Disability Inventory (Walker & Greene, 1991). Mediators included child catastrophizing as measured by the Pain Response Inventory and parents' perceived threat regarding their child's pain as measured by the Pain Beliefs Questionnaire (Walker et al., 2005). Results: Reductions in parents' perceptions of the threat of their child's pain mediated effects of the CBT intervention on reductions in both child- and parent-reported child pain, GI symptom severity, and disability. Similarly, reductions in children's catastrophic cognitions about their pain mediated effects of the CBT intervention on child- and parent-reported child pain, and child-reported GI symptom severity and disability. Conclusion: Changes in the way parents and children think about the child's pain, specifically reductions in concerns about its seriousness, appear to mediate reductions in symptoms and disability. This information should be incorporated into the clinical evaluation and medical treatment of these patients.