Children's and adolescents' experiences with functional abdominal pain: a qualitative study in Norway

Medical expenditures associated with abdominal and pelvic pain in the United States, 2017-2021

Abdominal and pelvic pain are common symptoms prompting medical care, yet little is known about their associated medical expenditures in the U.S. This study estimated the overall and age-specific incremental medical expenditures associated with abdominal and pelvic pain, and compared if the incremental expenditures differ by sex and presence of comorbid overlapping pain conditions. Using data from the 2017-2021 Medical Expenditure Panel Surveys (MEPS), a nationally representative cross-sectional survey on medical expenditures in the U.S., we estimated the incremental medical expenditures associated with abdominal and pelvic pain (ICD-10 indexed) for children (6-17 years), adults (18-64 years), and older adults (65-85 years), controlling for Andersen Behavioral Model factors. In our sample, 1.2% (1779/135,983) were classified with abdominal or pelvic pain. Adjusted incremental expenditures for abdominal and pelvic pain were $4325 (95% CI: $2670-$5981) per person, totaling $16.0 billion annually. Incremental expenditures were $1465 for children, $3439 for adults, and $9301 for older adults. In children, incremental expenditures were concentrated on office-based, outpatient, and emergency department visits. In adults, incremental expenditures were concentrated on office-based, outpatient, emergency department visits, and inpatient admissions. The estimated incremental medical expenditures were higher in males across all age groups. In individuals with abdominal or pelvic pain, comorbid pain conditions were associated with much higher additional incremental medical expenditures across all age groups ($6790 in children, $5262 in adults, and $6040 in older adults). Abdominal and pelvic pain substantially increased medical expenditures for children and adults, especially for those with comorbid overlapping pain conditions. PERSPECTIVE: Our nationwide study quantified the economic burden of abdominal and pelvic pain in the U.S., identifying key demographic and clinical cost drivers. Findings highlight the significant lifetime burden, the importance of pain management, the need to reduce costs for patients with overlapping pain, and the necessity of ongoing cost surveillance.

Exploring the emotional impact of pain on children and adolescents: A poetic meta-ethnography

Pain in early life can go unreported and untreated. We use poems to portray findings from a systematic review of qualitative research. The overall aim of the review was to distil essential experiences across pain conditions and contexts. This report, focusing on the emotional impact of pain, is one of a series of three analyses from one systematic review of qualitative research. We used meta-ethnography to synthesise research. We identified studies in English that explored acute and/or chronic child and/or adolescent pain experience. Findings were distilled into themes and poems co-created in English and Spanish. We included 189 reports (177 unique studies) incorporating 5875 people (at least 3484 reported as female). Most studies (93%) included participants aged 11-20 years (range 2-38). The studies explored acute (24% studies), chronic (75%), and acute/chronic (1%). We report seven themes: (1) Pain can be hard to bear; (2) Pain is scary; (3) Pain is constantly at the back of my mind: (4) Pain makes me feel like I am outside alone; (5) Pain makes school a hard fit; (6) Pain can hurt me deep inside; (7) Pain has changed me. Our themes highlight the emotional impact of pain across conditions and contexts. Art and science are both integral to leaps in understanding. The contribution of the Arts is their unique ability to reach audiences on an affective level, giving the potential to underpin compassionate care and policy. We invite readers to utilise these poems to start a conversation about young people's pain experiences. This systematic review was registered on the PROSPERO database (CRD42023429027). Ethical permissions are not required for an evidence synthesis. PERSPECTIVE: The voices of young people in pain are not always heard. This article presents themes, in poetic form, from a synthesis of 189 qualitative studies. Science and art are integral to leaps in understanding and inclusive arts-based research methods have the potential to underpin compassionate pain care for young people.

Children's and Their Parents' Experiences With Home-Based Guided Hypnotherapy: Qualitative Study

Background

Management of children with functional abdominal pain (FAP) or irritable bowel syndrome (IBS) is difficult in primary care. When education and reassurance do not alleviate symptoms, primary care physicians lack treatment options for children with FAP or IBS. Home-based guided hypnotherapy is a promising treatment because of its accessibility. To address feasibility, it is of utmost importance to take experiences from children and their parents into account.

Objective

We aimed to explore children's and their parents' experiences with home-based guided hypnotherapy for children with FAP or IBS.

Methods

This qualitative study used open-ended questions from a questionnaire and in-depth semistructured interviews with children and their parents who had a hypnotherapy intervention prescribed. The interviews were audio-recorded and transcribed verbatim. Data were collected and analyzed iteratively using thematic content analysis.

Results

A total of 76 children were eligible, and we collected questionnaire data from 56 children. A total of 23 interviews were conducted with 10 children and 15 parents. Six themes emerged from questionnaire data and interviews: impression of the exercises, not for everyone, influence of perceived effect, integrating exercises in daily life, content and practicalities of the website, and customization to personal preferences. Children with FAP or IBS experienced home-based guided hypnotherapy and the exercises differently, ranging from boring to fun. From interviews with the parents, it emerged that hypnotherapy is not suitable for everyone; for example, when children are very young or have a low developmental level, cannot sit still, cannot surrender to the exercises, or are too energetic or stressed, it might be difficult to comply. Experiences were shaped by the influence of a perceived effect and to which extent children were able to integrate exercises in daily life. The content and practicalities of the website also influenced experiences, and hypnotherapy that is adaptable to personal preferences, including by appearance and content, would be highly appreciated.

Conclusions

The children and parents experienced home-based guided hypnotherapy differently, ranging from boring to fun. Hypnotherapy might be difficult or boring for some children. The children enjoyed hypnotherapy when they liked the topic or story, felt positive effects, could easily integrate exercises in daily life, or enjoyed the website in general. The children's experiences and adherence can be further improved by adding short exercises and customizing hypnotherapy to their personal preferences on the website's appearance and content. This could increase effectiveness but must be studied further.

Qualitative study evaluating the expectations and experiences of Dutch parents of children with chronic gastrointestinal symptoms visiting their general practitioner

OBJECTIVES

Chronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education are, therefore, key components of the physician's management. Qualitative studies have shown how parents and children experience specialist paediatric care, yet less is known about general practitioners (GPs), who manage most cases in the Netherlands and have a more personal and enduring relationship with their patients. Therefore, this study evaluates the expectations and experiences of parents of children visiting a GP for chronic gastrointestinal symptoms.

DESIGN

We conducted a qualitative interview study. Online interviews were audio and video recorded, transcribed verbatim and independently analysed by the first two authors. Data were collected and analysed concurrently until data saturation was reached. Using thematic analysis, we developed a conceptual framework reflecting respondent expectations and experiences. We performed a member check of the interview synopsis and the conceptual framework.

SETTING

Dutch primary care.

PARTICIPANTS

We purposively sampled participants from a randomised controlled trial evaluating the effectiveness of faecal calprotectin testing in children with chronic gastrointestinal complaints in primary care. Thirteen parents and two children participated.

RESULTS

Three key themes emerged: disease burden, GP-patient relationship and reassurance. Often, the experienced disease burden and the pre-existing GP-patient relationship influenced expectations (eg, for further investigations or a sympathetic ear), and when a GP fulfilled these expectations, a trusting GP-patient relationship ensued that facilitated reassurance. We found that individual needs influenced these themes and their interrelationships.

CONCLUSION

Insights provided by this framework could help GPs managing children with chronic gastrointestinal symptoms in daily practice and may therewith improve the consultation experience for parents. Further research should evaluate whether this framework also holds true for children.

TRIAL REGISTRATION NUMBER

NL7690.

"A source of empowerment and well-being": Experiences of a dance and yoga intervention for young girls with functional abdominal pain disorders

Background

Functional abdominal pain disorders are common among children and adolescents worldwide and effective treatments are needed to alleviate suffering for these children and their families. This study aimed to explore the experience of participating in a combined dance and yoga intervention from the perspectives of girls aged 9-13 years with functional abdominal pain disorders.

Materials and Methods

A randomized controlled trial called Just in TIME (Try, Identify, Move and Enjoy) recruited 121 girls aged 9-13 years with functional abdominal pain disorders. The eight-month intervention combined dance and yoga twice a week, focusing on enjoyment, socialization and playful creativity in an undemanding and non-judgemental environment. The intervention group comprised 64 girls, of whom 25 were purposefully selected for this qualitative interview study. Semi-structured interviews were conducted and analysed using qualitative content analysis with an inductive approach.

Results

The girls' experiences of the Just in TIME intervention can be described as "A source of empowerment and well-being which facilitated personal growth and new ways of engaging in life". The main category was derived from six generic categories: "A sense of belonging", "Joy and emotional expression through movement", "Relief from pain", "More self-confident", "More active in daily life" and "A sense of calm."

Conclusions

Regular participation in an eight-month intervention with combined dance and yoga in a supportive and non-judgemental atmosphere can ease pain and strengthen inner resources, resulting in empowerment, well-being and a more active life for girls with functional abdominal pain disorders.

Trial registration

The Just in TIME study is available online at clinicaltrials.gov, ID: NCT02920268.

General practitioners' experiences with children and adolescents with functional gastro-intestinal disorders: a qualitative study in Norway

Objective: Functional gastrointestinal disorders (FGIDs) are common in children and adolescents. During 2016 and 2019, we investigated the experiences among parents of children with FGIDs and interviewed their children and adolescents during 2020. The aim of the present study was to explore the experiences among general practitioners (GPs) who treat this patient group.Design: Individual interviews with open-ended questions were audio recorded and transcribed, and subsequently analysed using descriptive content analysis.Setting: Urban and rural areas in two municipalities in Southern Norway. Participants: Twelve GPs practicing in the region were interviewed.Results: GPs generally feel competent treating these patients without referring them to hospital or specialists. Having known the patients and their families over time is important. Providing psycho-educational resources to the patients and parents is essential for their understanding that the pain is not dangerous. The importance of attending school was emphasised.Conclusions: The GPs' biopsychosocial focus and long-term follow-up care are essential in treating children and adolescents with FGIDs and their parents.KEY POINTSCurrent awarenessAbdominal pain is a common symptom in children and adolescents, for which an organic cause is seldom found.Main statementsGPs feel competent to treat children and adolescents who have functional gastro-intestinal disorders (FGIDs) without referring them to hospital or specialists. • A main task for GPs is to inform children, adolescents, and their parents that FGIDs are not a serious organic disease and that everyday life should continue.