Chronic abdominal pain: a psychological approach for the clinician

This paper is the result of collaborative work carried out with a small group of families over the past 6 years. The approach has evolved as we have worked together with challenging presentations of highly debilitating chronic abdominal pain. We present here a summary of a pragmatic approach yet to be formally evaluated, which has developed out of our struggle to engage families who present with high levels of distress about symptoms for which a medical explanation is being sought. We have focussed on close liaison between psychologist and clinician; in many centres access to a clinical psychologist can be problematic so the key messages in this paper are to help clinicians develop a psychosocial approach to management of chronic abdominal pain. The main themes in this paper are creating a working alliance with family, child and clinician, understanding and containing anxiety, the role of investigations, how to understand and educate about pain, solution-focussed therapy, maintaining the intervention and supporting the family.