Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives

Table 1 Diagnostic criteria for functional abdominal pain disorders in children and adolescents

H	FGIDs in children or adolescents
H2	Functional abdominal pain disorders
H2a	Diagnostic criteria for functional dyspepsia
	One or more of the following symptoms at least 4 d per month: (1) Postprandial fullness; (2) Early satiation; (3) Epigastric pain or burning not associated with defecation; and (4) After appropriate evaluation, the symptoms cannot be fully explained by another medical condition
	Within FD, the following subtypes are now adopted: (1) Postprandial distress syndrome; and (2) Epigastric pain syndrome
H2b	Diagnostic criteria for irritable bowel syndrome
	All of the following: (1) Abdominal pain at least 4 d per month (associated with one or more of the following: (a) Related to defecation; (b) Change in frequency of stool; and (c) Change in appearance of stool); (2) In children with constipation, the pain does not resolve with resolution of the constipation; and (3) After appropriate evaluation, the symptoms cannot be fully explained by another medical condition.
H2c	Diagnostic criteria for abdominal migraine
	All of the following occurring at least twice: (1) Paroxysmal episodes of intense, acute periumbilical, midline or diffuse abdominal pain lasting 1 h or more; (2) Episodes are separated by weeks to months; (3) The pain is incapacitating and interferes with normal activities; Stereotypical pattern and symptoms in the individual patient; (4) The pain is associated with 2 or more of the following: (a) Anorexia; (b) Nausea; (c) Vomiting; (d) Headache; (e) Photophobia; and (f) Pallor; and (5) After appropriate evaluation, the symptoms cannot be fully explained by another medical condition
H2d	Diagnostic criteria for functional abdominal pain not otherwise specified
	All of the following at least 4 times per month: Episodic or continuous abdominal pain that does not occur solely during physiologic events; Insufficient criteria for irritable bowel syndrome, functional dyspepsia, or abdominal migraine; After appropriate evaluation, the abdominal pain cannot be fully explained by another medical condition

All criteria must be fulfilled for at least 2 mo before diagnosis[1,2]. FGIDs: Functional gastrointestinal disorders; FD: Functional dyspepsia.

Table 2 Levels of evidence for different non-pharmacological therapies in the treatment of pediatric functional abdominal pain disorders

Therapy	Year of study	Type of sample	Level of evidence	Ref.
CBT	2010	C	II	[62]
	2013	C	II	[61]
	2017	C	II	[64]
	2019	C	II	[65]1
Meditation	2016	C	I	[74]
	2016	A	I	[72]
	2017	C	II	[73]1
	2017	A	III	[71]
Acupuncture	2008	A/C	I	[79]
	2011	C	II	[78]
	2011	C	IV	[81]
	2018	C	II	[80]1
Yoga	2011	C	IV	[92]
	2014	A/C	III	[94]
	2016	A/C	II	[95]
	2018	C	IV	[93]1
Massage	2008	C	III	[96]
	2012	C	III	[100]
	2013	C	III	[97]
	2013	C	III	[98]
	2020	C	III	[99]1
	2020	C	IV	[101]
Spinal manipulation	2007	C	II	[99]
	2009	C	II	[96]
	2012	C	II	[95]
	2019	C	II	[97]
	2020	C	II	[98]1
	2020	C	III	[26]
Moxibustion	2016	A	II	[100]
	2016	A/C	V	[102]
	2019	C	IV	[101]1
Physical activities	2018	C	II	[104]
	2019	C	II	[106]
	2019	C	III	[107]
	2020	C	II	[103]1
	2020	C	II	[105]

Adapted from the American Society of Plastic Surgeons rating scale for risk studies, 2011[108].

¹The references with best-level of evidence and most recent for each non-pharmacological therapy are highlighted.

A: Adults; C: Children; CBT: Cognitive behavioral therapy.