Treatment of Functional Abdominal Pain in Children: Evaluation of Relaxation/Guided Imagery and Chamomile Tea as Therapeutic Modalities
Treatment of Functional Abdominal Pain in Children: Evaluation of Relaxation/Guided Imagery and Chamomile Tea as Therapeutic Modalities
The purpose of this study is to investigate novel methods from CAM aimed at alleviating
 chronic pain related to functional bowel disorders in children. To that end, two CAM
 modalities will be investigated independently of each other, namely Guided Imagery and the
 use of Chamomile teas as a form of botanical therapy.

 Functional abdominal pain is defined as pain unrelated to an identifiable organic
 gastrointestinal disorder. The two subcategories of functional bowel disorders examined by
 this study will be RAP and IBS. The definition of RAP in children will follow Apley's classic
 definition of paroxysmal abdominal pain occurring in children between the ages of 4 and 16
 years that persists for more than three months, with a frequency of three or more episodes of
 abdominal pain over a three month interval. A similar pattern of abdominal pain relieved by
 defecation and/or associated with altered bowel habits and/or stool consistency will be
 defined as IBS. Despite the above definitions, note that the typical frequency of pain
 episodes associated with functional bowel disorders is at least three times per month.
Functional bowl disorders are defined as variable combinations of gastrointestinal symptoms
 that are not readily explained by structural or biochemical abnormalities. In children, these
 typically encompass irritable bowel syndrome and recurrent abdominal pain of childhood, two
 closely related disorders that reflect similar pathophysiologic processes. Both of these
 functional disorders are pervasive in children and possibly precede symptoms that persist
 into adulthood. These also account for considerable medical expense and morbidity resulting
 in school absenteeism. Existing therapies are limited, and the lack of success frequently
 frustrates parents, families, and physicians. The purpose of this pilot project is to explore
 the use of alternative medicine modalities to treat functional abdominal pain relying on
 those that address currently accepted pathophysiologic models of functional bowel disorders.
 Available evidence indicates 3 major mechanisms for these syndromes: altered intestinal
 motility, altered intestinal sensory thresholds, and psychosocial factors. Recurrent
 abdominal pain occurs in 10 to 30 percent of children and adolescents, and evidence suggests
 that many children with recurrent abdominal pain ultimately develop symptoms compatible with
 irritable bowel syndrome in adulthood. As many as 68% of school children suffering from
 recurrent abdominal pain have symptoms compatible with the diagnostic criteria for irritable
 bowel syndrome in adults. Colonic motility studies suggest exaggerated colonic motor function
 in patients with abdominal pain compared to controls, increased perception of abdominal pain
 following balloon distention of the rectum, and anxiety and depression compared to healthy
 children in the community. The approach to therapy including reassurance, fiber, and
 antispasmodics has not been effective in the long-term management of a recurrent abdominal
 pain in childhood.

 Accordingly, this pilot project will attempt to evaluate objectively two alternative
 modalities that address some of the mechanisms and could offer therapeutic options. In
 specific aim 1, a randomized controlled trial will be instituted to confirm the effectiveness
 of relaxation/guided imagery as a modality for treating functional bowel disorders in
 children and determine if guided imagery improves outcome beyond that achievable using
 relaxation training alone. In the second trial, the use of chamomile tea as an adjunct to
 traditional modes of treating functional bowel disorders in children will be assessed and
 compared to controls who do not receive chamomile tea. The primary outcome will be a
 reduction in pain measured by a Likert-scale pain inventory using faces as markers. The
 advantages of this inventory are that faces have been found to be universal across
 ethnicities and age groups. Secondary outcomes will include bowel habits and stool
 consistency, measures of functional disability using the Functional Disability Index, and
 psychiatric profiles using the Child Depression Inventory, Revised Children's Manifest
 Anxiety Scale, and Children's Global Assessment Scale. In addition, compliance measures will
 be assessed by phone contact by nurse clinicians. Data management will be undertaken to
 quantify the analyses already described.
Inclusion Criteria:

 -  Patients with Recurrent Abdominal Pain (RAP), as defined by the Apley's classic
 definition of paroxysmal abdominal pain occurring in children between the ages of 4
 and 16 years that persists for more than three months, with a frequency of three or
 more episodes of abdominal pain over a three month interval

 -  Patients with Irritable Bowel Syndrome (IBS) defined by a similar pattern of abdominal
 pain as for RAP patients, and relieved by defecation and/or associated with altered
 bowel habits and/or stool consistency