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Which treatments work best for children and adolescents with recurrent abdominal pain?

Posted on May 2nd 2018

Recurrent abdominal pain (RAP) is common among children, with up to 25% of children with RAP experiencing pain that interferes with their daily life. It is a diagnosis which is given once all other serious conditions have been ruled out, and is classified as pain that has no other identifiable cause. RAP is also associated with other symptoms including headaches, limb pain, and vomiting, and can lead to school absences, hospital admissions, and a higher chance of appendix removal.

The cause of RAP is unclear, and parents have often tried everything they can think of before taking their child to the doctor. Clinicians are also uncertain of the best way to treat it. There is no consensus about effective management, and no guidelines to follow, so there is an inconsistent approach to treatment.

A project, led by PenCLAHRC’s Evidence Synthesis Team (EST), aimed to address this inconsistency. It set out to discover what research has been conducted into RAP interventions, and which treatments, if any, are considered effective. The team conducted a large scale systematic review of relevant literature, which was able to identify three main approaches to treatment: dietary, pharmacological, and psychosocial (interventions based on psychological or behavioural therapy).

Within these approaches, three treatments were found to be promising: probiotics, Cognitive Behavioural Therapy (CBT), and hypnotherapy. However the team noted that further research into each therapy is needed before we can understand how they fully impact children with RAP.

Having suffered from RAP as an adolescent, PenCLAHRC Director, Professor Stuart Logan, had a particular personal interest in conducting this study. He remarks that:

‘It’s clear from this synthesis that there are treatments which clinicians can suggest, but further high quality research is needed to understand how best to help children with RAP.”

Stuart cautions that the evidence found for the effectiveness of probiotics, CBT and hypnotherapy was based largely on shorter-term outcomes, and that further research is required to assess whether reductions in pain are maintained longer term. Additionally, in the case of probiotics, further investigation into individual strains and dosages of probiotics is required. For CBT and hypnotherapy, more research is needed to establish how best to deliver the treatment (individually or in group sessions), and for how long.

The team have produced an animation detailing the findings of the study. The contents have been condensed from the results of three evidence synthesis reviews which informed the findings of the RAP Project. 


This animation was made by Ryan Turner, who worked with EST as part of a three month internship with PenCLAHRC’s communication team. You can read about his experiences working with EST on the Evidence Synthesis Team’s Blog.

For more information about the RAP project, visit the project page.