Complementary, holistic, and integrative medicine: recurrent abdominal pain.

device. Introduction Recurrent or chronic abdominal pain is a common and often perplexing condition, affecting between 15% and 35% of the pediatric population worldwide. Apley (1) first defined recurrent abdominal pain (RAP) in 1958 as at least three episodes of abdominal pain sufficient to disrupt a child’s daily activities over the previous 3 months. At the time of Apley’s study, only 5% of cases were found to have an organic cause. With newer diagnostic methods, up to one third of cases of RAP may be found to have organic causes. “Red flags” that might indicate specific organic diseases are: a family history of inflammatory bowel disease, fever, weight loss, night awakening, anemia, bloody stools, and localized tenderness. Most children who do not have specific organic disorders have functional RAP. The causes of functional abdominal pain still are poorly understood but are believed to be due to autonomic dysfunction or visceral hypersensitivity to stimuli such as intestinal bowel gas, an acute trigger such as a viral gastroenteritis, an increased central perception of pain, and altered bowel habits such as constipation. Perception of pain is mediated by temperamental, cultural, and psychological factors, such as anxiety or depression, and social stressors, such as learning difficulties and family stress. Functional abdominal pain may be categorized into four specific disorders, as described by the Rome III criteria for functional gastrointestinal (GI) disorders: functional dyspepsia, functional abdominal pain, irritable bowel syndrome (IBS), and abdominal migraine. Postprandial abdominal pain, with feelings of bloating, gas, or heartburn, is classified as dyspepsia and may be associated with gastroesophageal reflux. IBS is characterized by cramping pain with alteration in bowel movements. Episodic abdominal pain associated with headache and pallor may be an abdominal migraine. As with other illnesses, especially chronic conditions such as RAP, patients and families increasingly are turning to complementary and alternative medicine (CAM). In a group of 749 children visiting pediatric gastroenterology clinics in theNetherlands, 60%were found to have used CAM therapies. (2) Lack of effectiveness and incidence of adverse effects with standard medical therapy, along with school absenteeism, were the major reasons given for the use of such therapies. This article reviews the evidence-based CAM treatments for recurrent functional abdominal pain in children.