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Functional Abdominal Pain Program

Teen boys and girls talking and laughing together

There is nothing worse than seeing your child in pain. As a parent, you are the ultimate protector of your child, and you want the best possible medical care when you are searching for answers to your child’s abdominal pain. It can be frustrating for patients with abdominal pain to receive negative results on diagnostic tests and continue to suffer with chronic, unexplained pain. We understand the pain your child is feeling is real, and our pediatric experts are here to help.

The CHOC Functional Abdominal Pain Program specializes in caring for children and teens. Treatment plans combine a natural holistic approach with a conventional medical approach, pharmaceutical medications and the latest neuromodulation treatments, so you can rest assured that your child will receive the best possible medical care for his or her abdominal pain.

How We Treat Your Child's Abdominal Pain

The CHOC Functional Abdominal Pain Program specializes in working with patients and families to find ways to treat pain-related, functional gastrointestinal disorders, including irritable bowel syndrome, functional dyspepsia and functional abdominal pain syndrome. Dr. Ashish Chogle is the director of the program.

Our board-certified gastroenterologist, dietitian, psychologist, care coordinator and nurses team up with patients and their caregivers to assess and diagnose the type and possible cause of pain your child is experiencing. With you and your child’s input, we develop a personalized treatment plan. Our treatment plan is age and developmentally appropriate for your child, and involves educating you and your family on ways to help your child deal with their pain.

Treatments often begin with pediatric-focused integrative health treatments supervised by a board-certified physician, and then move on to traditional medical therapies and medications.

Treatments may include:

The Functional Abdominal Pain Program team also collaborates with CHOC’s neurologists, rheumatologists, cardiologists and pain management specialists as needed to ensure that patients receive appropriate and coordinated care. Parents can also work with our social workers in order to connect with resources that can help them and their children cope with school issues that might arise due to the chronic illness.

Neuromodulation Treatment

CHOC is one of the few pediatric centers in the nation that offers neuromodulation treatment for kids suffering from functional abdominal pain and nausea. It was also the first in the world to be named a Center of Excellence for Auricular Neuromodulation (IB-Stim) worldwide by NeurAxis, a medical technology company specializing in innovative neuromodulation therapies.

Neuromodulation treatment is an integrative approach that does not use medication or narcotics to alleviate abdominal pain and nausea. It uses a small device, called an IB-Stim, placed on the patient’s ear that delivers small amounts of electrical impulses to nerve branches in the ear, resulting in decreased pain and nausea. Ears have important nerve endings from the vagus and trigeminal nerves that in turn communicate with the sensory and emotional centers of the brain.

The IB-Stim device is placed once a week for four consecutive weeks and remains on the patient’s ear for at least five days.

Understanding Functional Abdominal Pain Syndrome

Functional bowel pain syndrome is pain that has no medical explanation. This means that although the child is in pain, there is no evidence of tissue damage. This pain impairs the daily life of the patients.

Although the exact cause is not known, nerve signals or chemicals secreted by the gut or brain, may cause the gut to be more sensitive to triggers that normally do not cause significant pain (such as stretching or gas bloating). This type of abdominal pain is often referred to as “functional abdominal pain.”

It is thought to have a bio-psycho-social basis, which means that multiple factors play a role in development and continuation of functional abdominal pain.

A child with functional abdominal pain syndrome often does not feel well. Their pain may prevent them from engaging in normal life activities like school, spending time with friends and engaging with family. They also may begin to worry about the foods they eat and begin eating or drinking less in order to make their pain stop. Children who have missed school and activities due to their pain may also become anxious about returning to “normal life” or become depressed about missing out on things they love.

The pain is usually located around the umbilicus (belly button), however the pattern or location of abdominal pain is not always predictable. The pain may occur suddenly or slowly increase in severity. The pain may be constant or may increase and decrease in severity.

Some children with functional abdominal pain may experience dyspepsia (upper abdominal pain associated with nausea, vomiting, and/or a feeling of fullness after just a few bites). Others may experience abdominal pain with bowel movements.

Diyya’s Story: Finding Pain Relief Without Medication

Diyya never thought the treatment for her chronic and debilitating stomach pain would be a small neurostimulation device placed behind her ear. Neuro-stim is a non-narcotic alternative for acute and chronic pain that alters the way pain pathways function.

Diyya's Story

Finding a Diagnosis

Upon referral to our program, you and your child will meet with our gastroenterologist, psychologist and dietitian so that they may discuss your child’s medical history and perform a physical evaluation. Many of our patients who are referred to the program have undergone some diagnostic tests with their pediatrician or previous gastroenterologist. Your CHOC gastroenterologist will look at the results of these tests, and may order additional tests to rule out gastrointestinal disorders and conditions. Tests that may be used include:

  • Blood tests. Blood tests are done to evaluate whether your child is anemic, has an infection, or has an illness caused by inflammation or irritation. Learn more about blood tests at CHOC.
  • Urine analysis and culture. These are done to help assess for urinary tract infections.
  • Stool sample. A stool sample is taken to check for the presence of microscopic blood in the stools. Your child’s doctor may also check for the presence of inflammation with stool calprotectin and to check for GI infections. Learn more about stool tests.
  • Lactose breath hydrogen test. This test is done to determine if your child is intolerant to lactose, a sugar present in milk and milk products. Learn more about lactose breath hydrogen tests.
  • Abdominal X-ray. A simple study that will give the health care provider an idea of how the internal organs look. Learn more about X-rays at CHOC.
  • Abdominal ultrasound. A diagnostic imaging technique that creates images from the rebound of high frequency sound waves in the internal organs. Learn more about ultrasounds at CHOC.
  • Endoscopy. A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing. Learn more about endoscopy.
  • Colonoscopy. A test that uses a long, flexible tube with a light and camera lens at the end (colonoscope) to examine inside the large intestine. Learn more about colonoscopy.

Integrative Health at CHOC

In addition to the services provided as part of the Functional Abdominal Pain Program, CHOC has the region’s only hospital-based and pediatric-focused integrative complementary medicine program. We proudly offer evidence-based treatments such as massage, acupuncture, aromatherapy, biofeedback, hypnotherapy and guided imagery to relieve troublesome or painful symptoms, and improve well-being with the goal of creating a better quality of life for patients and their families.

Learn more about integrative health treatments at CHOC.