While adults often suffer from backache or headache, children repeatedly complain of twinges and pain in their tummies. The reason could be an infection or organic disease of the gastrointestinal tracts, but in most children no physical cause for the pain can be found. The pain is real, but medical results offer no explanation.
Petra Warschburger, Professor of Counseling Psychology at the University of Potsdam, knows this problem. Her research focuses on chronically ill children and adolescents suffering functional abdominal pain. “This is recurrent abdominal pain that the children experience but for which doctors find no organic cause,” she explains. This topic is not new to her. Warschburger and her team have been focusing on the quality of life of chronically ill children for some years now, particularly of those with abdominal pain syndromes. Some children suffer severe psychological strain that may even be worsened by endless visits to doctors and waiting in vain for a diagnosis. “These children have the impression that people think they are lying and then feel even worse,” the psychologist says. Warschburger intensively investigated functional abdominal pain as part of the Graduate School/ of Developmental Psychopathology and Evidence-based Intervention she led together with Professor Günter Esser from 2007-2010. She and a PhD student developed a program for psychological interventions to show children an alternative way of coping with pain. The promising results of the final evaluation highlighted the efficacy.
Her current clinical trial “Stop the Pain” picks up on this research. The multicenter examination, running from October 2013 to September 2016, is being funded by the German Research Association (DFG). Patients are recruited for the trial in outpatient clinics together with certified pediatric gastroenterologists in Berlin, Ulm, Düsseldorf, Darmstadt, and Hamburg. They look for children who have had abdominal pain for more than 2 months with episodes occurring at least once a week. Detailed examinations first clarify whether there are organic causes, for example lactose or fructose intolerance. “If there are no organic causes and the pain still persists, we talk about functional abdominal pain. The parents are then asked if they would like their children to participate in the study,” Warschburger explains. She and her assistant Claudia Calvano are developing guideline-based medical and psychological diagnostics together with the pediatric gastroenterology centers. “It was important to us that the gastroenterological outpatient clinics offer our program on site. Psychologists do provide the training for the children but it takes place in a different context, which makes participation in the treatment easier and will increase its acceptance.”
The children in the study are randomized into two training groups. The two training programs and random allocation are key criteria to validate and interpret the results.
Altogether 112 girls and boys aged 7-12 will to take part in the intervention program. The children initially attend six training sessions. Two additional sessions are for the parent groups. Two weeks after the training, three and twelve months after the training, parents and children are asked to fill in questionnaires to report how they experienced pain and associated factors, and short interviews are conducted with the children. Prof. Warschburger and her team then evaluate if and to what extent the intervention groups differ, for example with respect to pain reduction, increasing health-related quality of life, and improved self-efficacy.
In general, group sessions proofed to be very helpful. There are 3-8 children in each group session. By meeting other children with the same problem, they learn that they are not alone. They can learn from and support each other. “Apart from that, simply having other children around is much more fun and an important motivating factor,” Warschburger says.
The aim is to establish a positive experience that the girls and boys can integrate into their everyday lives. The children regularly observe their pain and keep a “pain diary”. “There are, of course, also concerns that the children may experience more abdominal pain by dealing with and thinking about the topic so much. Our studies, however, produced no evidence of this,” the researcher explains. “We will only be able to give a definite answer after the study has been completed.”
Experience shows, Warschburger says, that adolescents suffering from functional abdominal pain often develop a life of ailment: Abdominal pain often turns into headaches in adolescence and back pain in adulthood. Parents of children suffering from functional abdominal pain often had similar problems themselves. The history of pain is sometimes passed on from generation to generation because children learn from their parents how to deal with pain, and inappropriate pain management strategies are passed on. “Acute pain is a clear warning but chronic pain has lost this function. The traffic lights are permanently yellow, so to speak. These people begin to restrict their activities in everyday life. This is the point when intervention is necessary to head off potential isolation from the psychosocial environment.”
In addition to functional abdominal pain, Warschburger also engage in treatment of children suffering from atopic dermatitis, asthma, or obesity. Her aim is to develop training programs to help parents and children to cope with various disorders. In the long-term, the psychological methods are expected to change symptoms and improve quality of life. The counselling psychologist and her team collaborate with nutritionists and physicians but focus on psychosocial aspects. “Many diseases, for example obesity, are closely related to diet and physical activity. Genetics may play a role as well,” Warschburger explains. “There are also psychosocial aspects. We eat not only when we are hungry but also when we are under stress. Stress occurs when we are teased, for example. Teasing someone for being overweight leads to more eating, and a vicious cycle ensues. There are often a number of factors for a disorder.
The counselling psychologist’s research has a direct practical reference, as in the case of functional abdominal pain. Some colleagues approached her and pointed out the urgent need for functional pain treatment, which ultimately led to a successful symbiosis between research and health care routine. “If our program can verify the efficacy, we will have valid arguments to demand that the therapy becomes a statutory benefit, i.e. health insurance companies will cover it,” Warschburger says. “Since this field still lacks standard treatment, mere alleviation for children and their parents would be a big step.”
The Researcher
Prof. Petra Warschburger is Professor at the Chair of Counselling Psychology at the University of Potsdam and Head of the Patient Training and Counselling Center (PTZ).
Contact
Universität Potsdam
Department Psychologie
Karl-Liebknecht-Str. 24–25
14476 Potsdam
E-Mail: warschbuuni-potsdampde
The Project
Stop the pain – A multicenter, randomized-controlled study of a cognitive-behavioral intervention for children with functional abdominal pain
Duration: 2013–2016
Participating: Prof. Dr. Petra Warschburger (Head),
Dipl.-Psych. Claudia Calvano
Funded by: German Research Association (DFG)
Text: Sophie Jäger
Online-Editing: Agnes Bressa, Translation: Susanne Voigt
Contact Us: onlineredaktionuuni-potsdampde