Functional abdominal pain disorders (FAPDs) in children are common (14%) and abdominal pain has increased rapidly in children during the last ten years in Sweden. Many children with FAPDs have low quality of life, missed school days, and about 30-40% suffer from psychiatric comorbidity. FAPDs are often sustained into adulthood and a large Swedish cohort study showed that abdominal pain during childhood is an independent strong predictor anxiety and depression later in life. Internet-cognitive behavioral therapy (Internet-CBT) can improve FAPD symptoms, but a significant number of children does not respond to the treatment. We will here determine the pain regulation in children with FAPDs, compared with healthy controls, and assess: What aspects of the child's pain regulation is related to improvement for children with FAPDs engaging in Internet-CBT? Does some aspects of the child's pain regulation change during treatment?
Study Type
OBSERVATIONAL
Enrollment
80
Ten weekly modules for children and ten weekly modules for parents. Exposure-based cognitive behavioral therapy delivered online with asynchronous support via text messages from psychologists.
Karolinska Institutet
Stockholm, Karolinska Institutet, Sweden
RECRUITINGPressure pain threshold on navel
Algometer pressure (in kPa) for the pain threshold
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Unpleasantness of pressure pain threshold on navel
Children rate their unpleasantness on a scale 0-10
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Pressure pain threshold on thigh
Algometer pressure (in kPa) for the pain threshold
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Unpleasantness of pressure pain threshold on thigh
Children rate their unpleasantness on a scale 0-10
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Conditioned pain modulation
Conditioned pain: hand in 10°C cold water, test pain: presseure pain thresholds by algometer on the participant's thigh. Difference in pressure pain thresholds with and without the simultaneous conditioned stimuli
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Temporal summation
Pinprick stimuli of low pain, one time, then repeated 10 times. Pain after repeated stimulus minus pain for the single stimulus.
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Sensory attenuation of pain
Pressure pain thresholds (kPa) applied by the child or the experimenter. Sensory attenuation = difference in pain threshold between self-induced and experimenter induced
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Resting state fMRI
Differences in network connectivity (Yeo networks + subcortical areas) and between seed (trunk in the somatosensory cortex) to Yeo brain networks + subcortical areas).
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
fMRI during low pain compared with non-painful tactile stimulus
Differences in network connectivity (Yeo networks + subcortical areas) and between seed (trunk in the somatosensory cortex) to Yeo brain networks + subcortical areas).
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Pediatric Quality of Life Inventory Gastrointestinal Symptom Scale (PedsQL Gastro)
Self-assessed questionnaire of abdominal symptoms
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Faces Pain Rating Scale (FACES)
Self-assessed questionnaire of pain intensity
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Visceral sensitivity Index, child-adapted short version (VSI-C)
Self-assessed questionnaire of gastrointestinal-specific anxiety
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
Irritable bowel syndrome-behavioral responses questionnaire, child-adapted short version (BRQ-C)
Self-assessed questionnaire of gastrointestinal-specific avoidance and controlling behaviors
Time frame: Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children)
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