ORLANDO – Therapeutic biofeedback reduces pain intensity, pain frequency, and health care utilization among children with recurrent abdominal pain, according to two posters presented at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Biofeedback “is noninvasive and it empowers the kids. It gives them the tools to make themselves better,” Dr. Warren Shapiro said in an interview.
“Biofeedback has long-lasting effects.” Unlike more common acute interventions, “it's really a long-lasting solution,” coauthor Eric Sowder, Ph.D., said.
The researchers decided to assess biofeedback in this pediatric population because “there has not been very much in terms of long-lasting therapies for abdominal pain,” said Dr. Shapiro, a pediatric gastroenterologist at the Southern California Kaiser Permanente Medical Group in San Diego.
Data indicate biofeedback is feasible for adults in a primary care setting (Appl. Psychophysiol. Biofeedback 2004;29:79–93). “It has not been researched as well in kids. But we see they are getting better,” said Dr. Sowder, psychological assistant in biofeedback and behavioral medicine, Alliant International University, San Diego.
Dr. Shapiro, Dr. Sowder, and their associates assessed 64 children referred to pediatric gastroenterology with recurrent abdominal pain. Pain frequency, intensity, and autonomic nervous system functioning were compared before and after an average of six biofeedback sessions.
Biofeedback might help children with recurrent abdominal pain to adapt their pain behavior. The technique addresses a proposed deficit in their autonomic nervous system response to stress. Also, biofeedback might help these patients counter an enhanced subjective response to pain.
To test these theories, pediatric gastroenterologists referred participants with recurrent abdominal pain. Patient ages ranged from 7 to 18 years, and 70% were female. Pain episodes per week were compared before and after completion of biofeedback, and pain intensity was rated on a 1–10 visual analog scale.
Biofeedback significantly reduced the intensity and frequency of pain. Mean pain intensity ratings decreased from 6 to 2.5; mean number of pain episodes per week decreased from seven to three.
Researchers compared peak-to-valley differences in respiratory sinus arrhythmia (RSA) to reflect autonomic nervous system functioning. The RSA during rest increased significantly, from 13.6 before biofeedback to 22.5 afterward. The RSA during slow-paced breathing likewise increased, from 22 to 32.5.
These findings suggest that biofeedback should be considered a first-line therapy for childhood recurrent abdominal pain, the researchers wrote. “We want to do more research and have a control group, and maybe compare this to hypnosis,” Dr. Sowder said.
A second study demonstrated that “primary care and [emergency department] visits come down” with biofeedback, Dr. Sowder said. He, Dr. Shapiro, and a colleague demonstrated a significant reduction in health care utilization following biofeedback training of children with recurrent abdominal pain.
The researchers identified 39 children (mean age 13 years) who were diagnosed with recurrent abdominal pain and completed a mean of five biofeedback sessions. They compared health care utilization 2 years prior to biofeedback and 1 year afterward in a Kaiser Permanente database.
Biofeedback significantly reduced mean primary care visits from 10.3 to 3.8 per year; emergency department visits from 0.69 to 0.05; prescriptions from 8.8 to 4.5; and diagnostic tests from 0.77 to 0.08.