Santucci Neha R, Sahay Rashmi, El-Chammas Khalil I, Graham Kahleb, Wheatley Mikaela, Vandenbrink Madeleine, Hardy Jennifer, Fei Lin
Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Pediatrics, University of Cincinnati, Cincinnati, OH, United States.
Front Pain Res (Lausanne). 2023 Sep 19;4:1251932. doi: 10.3389/fpain.2023.1251932. eCollection 2023.
Standard medical therapy (SMT) in children with functional abdominal pain disorders (FAPD) includes cyproheptadine and amitriptyline. While percutaneous electrical nerve field stimulation (PENFS) has shown benefit, no study has compared outcomes of PENFS to SMT. We aimed to examine changes in abdominal pain, nausea and disability before and after treatment and compare outcomes between treatments.
The records of FAPD patients ages 11-21 years, treated with 4 weeks of PENFS, cyproheptadine or amitriptyline were reviewed. Outcomes were evaluated using validated questionnaires [Abdominal Pain Index (API), Nausea Severity Scale (NSS), and the Functional Disability Inventory (FDI)] at baseline and follow-up within 3 months (FU).
Of 101 patients, 48% received PENFS, 31% cyproheptadine and 21% received amitriptyline. Median ages were 17 (15-19), 16 (15-18) and 15 (11-16) years respectively and the majority were females (75%, 90% and 52% respectively). In the PENFS group, API ( = 0.001), NSS ( = 0.059) and FDI ( = 0.048) were significantly lower at FU. API ( = 0.034) but not NSS and FDI ( > 0.05) decreased significantly at FU in the amitriptyline group. API, NSS and FDI did not change significantly with cyproheptadine at FU ( > 0.05). FU API scores were lower in PENFS vs. cyproheptadine ( = 0.04) but not vs. amitriptyline ( = 0.64). The FDI scores were significantly lower in the amitriptyline vs. cyproheptadine group ( = 0.03).
Therapy with PENFS showed improvements in abdominal pain, nausea and disability while amitriptyline showed improvements in abdominal pain within 3 months of treatment. PENFS was more effective than cyproheptadine in improving abdominal pain. Amitriptyline improved disability scores more than cyproheptadine and showed promise for treatment. PENFS may be a good non-pharmacologic alternative for FAPD.
功能性腹痛障碍（FAPD）患儿的标准药物治疗（SMT）包括使用赛庚啶和阿米替林。虽然经皮电神经场刺激（PENFS）已显示出疗效，但尚无研究将PENFS与SMT的疗效进行比较。我们旨在研究治疗前后腹痛、恶心和残疾状况的变化，并比较不同治疗方法的疗效。
回顾了年龄在11至21岁之间接受4周PENFS、赛庚啶或阿米替林治疗的FAPD患者的记录。在基线和3个月内的随访（FU）时，使用经过验证的问卷[腹痛指数（API）、恶心严重程度量表（NSS）和功能残疾量表（FDI）]对疗效进行评估。
101例患者中，48%接受了PENFS治疗，31%接受了赛庚啶治疗，21%接受了阿米替林治疗。中位年龄分别为17（15 - 19）岁、16（15 - 18）岁和15（11 - 16）岁，大多数为女性（分别为75%、90%和52%）。在PENFS组中，随访时API（P = 0.001）、NSS（P = 0.059）和FDI（P = 0.048）显著降低。在阿米替林组中，随访时API（P = 0.034）显著降低，但NSS和FDI未显著降低（P > 0.05）。使用赛庚啶治疗时，随访时API、NSS和FDI均未显著变化（P > 0.05）。随访时，PENFS组的API评分低于赛庚啶组（P = 0.04），但与阿米替林组相比无差异（P = 0.64）。阿米替林组的FDI评分显著低于赛庚啶组（P = 0.03）。
PENFS治疗在腹痛、恶心和残疾状况方面均有改善，而阿米替林在治疗3个月内对腹痛有改善作用。PENFS在改善腹痛方面比赛庚啶更有效。阿米替林在改善残疾评分方面优于赛庚啶，显示出治疗前景。PENFS可能是FAPD一种良好的非药物替代治疗方法。
