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News and Features Advancing the care of chronic abdominal pain using the biopsychosocial model

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The abdominal pain program brings relief to patients

Because chronic abdominal pain is often the result of complex interactions between the mind and body, finding the source of the pain, along with a solution, is often a frustrating endeavor for both physicians and patients.

The Abdominal Pain Program at Children’s Mercy is helping eliminate that frustration with integrated, medical-psychological treatment that examines abdominal pain from a variety of perspectives.

Craig Friesen, MD
Using the Biopsychosocial Model for Diagnosis and Treatment

Using a multi-disciplinary biopsychosocial approach, team members assess biological, psychological and environmental factors to diagnose and treat patients. Outcomes offer proof that the coordinated care is improving quality of life.

"We are a very integrated research, clinical and teaching program, so what we do is about treating patients and learning from them, improving what we do and disseminating the information so that the whole field can move forward," said Jennifer V. Schurman, PhD, Clinical Psychologist and Co-Director of the Abdominal Pain Program. 

Treating Abdominal Pain Starts with Transforming the Traditional Clinical Model 

"The traditional model is look for disease, treat it if you find it; if you don’t find it, send the patient to a psychologist," said Craig Friesen, MD, Division Director, Gastroenterology and Co-Director of the Abdominal Pain Program. "What we’re doing is looking for targets of intervention—the biological factors we can target along with psychological and social factors. Using all of that information we continuously adapt our clinical model to get a greater understanding of the complexity of the condition and how to treat it."

The Abdominal Pain Program staff includes two full-time psychologists, two full-time gastroenterology physicians, three advanced practice providers, three biofeedback technicians and four full-time nurses.

Their interdisciplinary focus follows patients from the beginning of treatment through follow up.

"At the very first patient visit there’s a gastroenterologist and a psychologist in the room to present an integrated plan and help families understand how psychosocial aspects interact with the biological, and how it’s all part of the treatment program,” Dr. Friesen said. "We find that people are very receptive to our approach. They don’t feel labeled, they are satisfied and their response is reflected in our outcomes."

Searching for a Cure – and Standardized Treatment Approach

Research within the Abdominal Pain Program includes 12 open study protocols. Within one of the studies, researchers are using ecological momentary assessment to gain insight into potential targets of abdominal pain treatment. The assessment samples patients’ symptoms, behaviors, and experiences during regular intervals every day to determine what triggers pain to start or causes it to become more intense.

Children’s Mercy also is gearing up to lead the evaluation of a web-based education program called Gutstrong that blends psychology, education, parent training and coaching usually provided within a clinic setting. Targeted at children without access to routine psychology services, Gutstrong is designed to supplement gastroenterology treatment with psychosocial support by allowing these children and their parents to access relevant information and coaching via their home computer or mobile handheld device. 

Once this multi-site study is complete, the goal is to expand the availability of Gutstrong by rolling it out nationally and adapting it for use in primary care settings.

Research Collaboration

A collaborative effort with pediatricians and family care physicians is also under way at Children’s Mercy to collect and share information about abdominal pain symptoms and treatment. Information about types of pain, treatment, and quality of life issues are gathered at regular intervals from participating families, allowing researchers to study each patient’s trajectory of change and determine what treatment approaches best support positive patient outcomes.

"We’re also looking at developing tools physicians can use to quickly identify conditions and treat them," said Dr. Friesen. "We know that if you can classify patients, at least in a subspecialty practice, and provide the proper treatment, half of them will respond almost immediately. We’re working to make this classification tool available to physicians nationally. Because our project is web-based, our plan is to eventually allow any physician in the county to enroll, feed in their data and get the information they need to effectively treat abdominal pain within their practice."

The Abdominal Pain Program’s ongoing successes continue to gain national attention. During the past several years, staff have made 59 national meeting presentations, published 31 manuscripts and written three book chapters.

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