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| Name | Class |
|---|---|
| Child and Adolescent Psychiatry, Stockholm | INDUSTRY |
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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?
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FAPDs | Children 8-17 years with FAPDs |
| |
| Controls | Children 8-17 years without FAPDs |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Internet-delivered cognitive behavioral therapy | Other | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Pressure pain threshold on navel | Algometer pressure (in kPa) for the pain threshold | 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 | Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children) |
| Measure | Description | Time Frame |
|---|---|---|
| Pressure pain threshold on thigh | Algometer pressure (in kPa) for the pain threshold | 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 |
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Inclusion Criteria:
Children 8-17 years with FAPDs: Have been offered treatment at BUP Internetbehandling for FAPDs.
Children 8-17 years without FAPDs: Not affected by recurrent (every week) or persistant pain during the last year.
Exclusion Criteria:
Contraindication for MR (metal implant or metal object in body, claustrophobia, pregnancy)
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Children (n=40) aged 8-17 with FAPDs who are patients at BUP Internetbehandling within the Child and Adolescent Psychiatry in Stockholm will be included in the study. Their behavioral and neural pain mechanisms will be assessed before and after Internet-CBT. We will also recruit healthy control children (n=40) aged 8-17 to compare the pain regulation between the groups. First, we will ask whether there are healthy siblings to the participating children with FAPDs that are willing to participate. If we don't get enough children by asking siblings, social media will be used in the recruitment.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Maria Lalouni, PhD | Contact | +46709473148 | maria.lalouni@ki.se | |
| Viktor Vadenmark, MSc | Contact | +46707220594 | viktor.vadenmarklundqvist@ki.se |
| Name | Affiliation | Role |
|---|---|---|
| Maria Lalouni, PhD | Karolinska Institutet | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Karolinska Institutet | Recruiting | Stockholm | Karolinska Institutet | 17177 | Sweden |
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Children rate their unpleasantness on a scale 0-10 |
| 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 | 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. | 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 | 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). | 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). | 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 | 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 | 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 | 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 | Baseline differences and baseline to follow-up after 10 week's treatment (or 10 week's wait for healthy children) |