The goal of therapy is redirected from finding a cure to coping with and overcoming the problem. This approach challenges the notion that the child cannot resume normal function until the pain is completely gone. It encourages active, problem-focused coping, and discourages passive acceptance—which is associated with greater symptom burden and functional impairment.
Work with parents to reinforce the child’s health-promoting behaviors and minimize negative and social reinforcements (secondary gain) associated with RAP. Advise parents to:
- encourage and reward full school attendance
- avoid home-bound instruction
- expect the child to function despite physical distress
- insist that the child perform age-appropriate household chores and other responsibilities.
Self-management skills—such as relaxation training, hypnosis, biofeedback, and guided imagery—may help reduce pain and manage physiologic arousal.16 Deception strategies such as placebo or sham interventions are unethical and impractical.
Related resources
- Campo JV. Functional recurrent abdominal pain in children and adolescents. Digestive Health Matters 2003;12(3):15-7.
- International Foundation for Functional Gastrointestinal Disorders. www.iffgd.org
- University of Pittsburgh. Advanced Center for Interventions and Services Research on Early Onset Mood and Anxiety Disorders. www.moodykids.org
Drug brand names
- Alosetron • Lotronex
- Citalopram • Celexa
- Clonazepam • Klonopin
- Escitalopram • Lexapro
- Famotidine • Pepcid
- Fluoxetine • Prozac
- Fluvoxamine • Luvox
- Sertraline • Zoloft
- Tegaserod • Zelnorm
Disclosure
Dr. Campo’s work has been supported by the National Institute of Mental Health (grant MH01780) and in part by the Advanced Center for Interventions and Services Research on Early Onset Mood and Anxiety Disorders (grant MH66371). He also receives grants from Forest Pharmaceuticals and is a consultant to Eli Lilly and Co.