Exploring the Use of Complementary and Alternative Medicine in Pediatric Functional Abdominal Pain Disorders

Functional abdominal pain disorders, which include functional dyspepsia, irritable bowel syndrome and abdominal migraine, are influenced by both biological and psychosocial factors. The underlying mechanisms are complex and largely unknown, making treatment challenging.

Researchers from Nationwide Children’s Hospital recently investigated the use of complementary and alternative medicine among children with functional abdominal pain disorders. They found that nearly all the patients surveyed used at least one kind of complementary and alternative medicine (CAM), underscoring that clinicians should familiarize themselves with these modalities.

The researchers surveyed patients attending a follow-up visit for functional abdominal pain disorders, collecting data on patients’ use of conventional therapies and CAM, opinions about CAM, and perception of their providers’ knowledge of CAM.

Of 100 respondents, 96% reported using at least one form of CAM, as defined by the researchers. The most widely used CAM category was supplements or vitamins, used by 71% of patients. Dietary changes were undertaken by 69% of respondents. A little fewer than half of patients saw alternative care providers outside of their primary care provider and pediatric gastroenterologist, most commonly a counselor or psychologist.

Although nearly all the respondents used at least one form of CAM, nearly half of them did not consider these therapies to be CAM modalities.

“This finding shows that practitioners might not know what sorts of CAM their patients are using to treat their symptoms if they do not specifically ask about it,” says Steven Ciciora, MD, director of division educational activities in the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s and one of the study’s authors.

Another takeaway from the survey is that a majority of patients felt neutral or insufficiently informed regarding CAM. Many pediatric patients look to their gastroenterologists as a source of information.

“I think it is a sign that we, as physicians, need to become more familiar with these therapies because our patients are using them, whether they label them as CAM or not,” says Dr. Ciciora, who is also an assistant professor of Pediatrics at The Ohio State University College of Medicine.

Dr. Ciciora concludes that pediatric gastroenterologists can be a source of expertise and guidance on how to integrate CAM in the treatment of functional abdominal pain disorders. He says it is important for providers to familiarize themselves with those CAM modalities that have been shown to be effective in these disorders.

For instance, a proprietary blend of herbs and supplements called Iberogast has been shown to be of benefit in functional dyspepsia and irritable bowel syndrome and there is evidence that highly concentrated peppermint oil can also help with abdominal pain. There is also support for the use of psychological interventions, such as cognitive behavioral therapy or hypnotherapy, for the treatment of functional abdominal pain disorders.

“If you have a patient looking for CAM therapies, there is a laundry list of things you can try,” says Dr. Ciciora. “You would be best served, however, by recommending those modalities that have been shown to be effective.”

Reference:

Ciciora SL, Yildiz VO, Jin WY, Zhao B, Saps M. Complementary and alternative medicine use in pediatric functional abdominal pain disorders at a large academic center. Journal of Pediatrics. 2020 Aug 13:S0022-3476(20)31009-X.

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