***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The aim of this pilot study was to evaluate the effect of yoga exercises on pain frequency and intensity and on quality of life in children with functional abdominal pain . DESIGN 20 children , aged 8 - 18 years , with irritable bowel syndrome ( IBS ) or functional abdominal pain ( FAP ) were enrolled and received 10 yoga lessons .  Pain intensity and pain frequency were scored in a pain diary and quality of life was measured with the Kidscreen quality of life question naire ( KQoL ) . RESULTS In the 8 - 11 year old group and the 11 - 18 year old group pain frequency was significantly decreased at the end of therapy ( p=0.031 and p=0.004 ) compared to baseline . In the 8 - 11 year group pain intensity was also significantly decreased at this time point ( p=0.015 ) . After 3 months there still was a significant decrease in pain frequency in the younger patient group ( p=0.04 ) and a borderline significant decrease in pain frequency in the total group ( p=0.052 ) . Parents reported a significantly higher KQoL-score after yoga treatment . CONCLUSION This pilot study suggests that yoga exercises are effective for children aged 8 - 18 years with FAP , result ing in significant reduction of pain intensity and frequency , especially in children of 8 - 11 years old BACKGROUND Adolescents with irritable bowel syndrome ( IBS ) frequently experience interference with everyday activities . Mind-body approaches such as yoga have been recommended as interventions for patients with IBS . Despite promising results among adult sample s , there have been limited studies exploring the efficacy of yoga with pediatric patients . OBJECTIVE To conduct a preliminary r and omized study of yoga as treatment for adolescents with IBS . METHODS Twenty-five adolescents aged 11 to 18 years with IBS were r and omly assigned to either a yoga or wait list control group . Before the intervention , both groups completed question naires assessing gastrointestinal symptoms , pain , functional disability , coping , anxiety and depression . The yoga intervention consisted of a 1 h instructional session , demonstration and practice , followed by four weeks of daily home practice guided by a video . After four weeks , adolescents repeated the baseline question naires . The wait list control group then received the yoga intervention and four weeks later completed an additional set of question naires . RESULTS Adolescents in the yoga group reported lower levels of functional disability , less use of emotion-focused avoidance and lower anxiety following the intervention than adolescents in the control group . When the pre- and postintervention data for the two groups were combined , adolescents had significantly lower scores for gastrointestinal symptoms and emotion-focused avoidance following the yoga intervention . Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS . CONCLUSIONS Yoga holds promise as an intervention for adolescents with IBS OBJECTIVE : This study was design ed to develop and to test a home-based , guided imagery treatment protocol , using audio and video recordings , that is easy for health care professionals and patients to use , is inexpensive , and is applicable to a wide range of health care setting s. METHODS : Thirty-four children , 6 to 15 years of age , with a physician diagnosis of functional abdominal pain were assigned r and omly to receive 2 months of st and ard medical care with or without home-based , guided imagery treatment . Children who received only  st and ard medical care initially received guided imagery treatment after 2 months . Children were monitored for 6 months after completion of guided imagery treatment . RESULTS : All treatment material s were reported to be self-explanatory , enjoyable , and easy to underst and and to use . The compliance rate was 98.5 % . In an intention-to-treat analysis , 63.1 % of children in the guided imagery treatment group were treatment responders , compared with 26.7 % in the st and ard medical care – only group ( P = .03 ; number needed to treat : 3 ) . Per- protocol analysis showed similar results ( 73.3 % vs 28.6 % responders ) . When the children in the st and ard medical care group also received guided imagery treatment , 61.5 % became treatment responders . Treatment effects were maintained for 6 months ( 62.5 % responders ) . CONCLUSION : Guided imagery treatment plus medical care was superior to st and ard medical care only for the treatment of abdominal pain , and treatment effects were sustained over a long period OBJECTIVE : This r and omized controlled trial investigated the effectiveness of a 6-session protocol ized cognitive behavior therapy ( CBT ) compared with 6 visits to a pediatrician ( intensive medical care ; IMC ) for the treatment of pediatric functional abdominal pain ( FAP ) . METHODS : One hundred four children aged 7 to 18 were r and omized to CBT or IMC . CBT was delivered primarily by trained master ’s degree students in psychology ; IMC was delivered by pediatricians or pediatric gastroenterologists . Assessment s were performed pretreatment , posttreatment , and at 6- and 12-month follow-up . Primary outcomes were level of abdominal pain ( AP ) as reported on question naires and diaries . Secondary outcomes were other gastrointestinal complaints , functional disability , other somatic complaints , anxiety , depression , and quality of life . RESULTS : Both CBT and IMC result ed in a significant decrease in AP ( P < .001 ) , but no significant difference was found between the treatments in their effectiveness ( P > .05 for all end points ) . According to the question naire-derived data , 1 year after treatment , 60 % of children that received CBT had significantly improved or recovered , versus 56.4 % of children receiving IMC , which did not significantly differ ( P = .47 ) . These percentages were 65.8 % versus 62.8 % according to the diary-derived data , which also did not significantly differ ( P = .14 ) . Additionally , nearly all secondary outcomes improved after treatment . CONCLUSIONS : CBT was equally effective as IMC in reducing AP in children with FAP . More research into the specific working mechanisms of CBT for pediatric FAP is needed This study describes the results of a controlled clinical trial involving 44 7- to 14-year-old children with recurrent abdominal pain who were r and omly allocated to either cognitive-behavioral family intervention ( CBFI ) or st and ard pediatric care ( SPC ) .  Both treatment conditions result ed in significant improvements on measures of pain intensity and pain behavior . However , the children receiving CBFI had a higher rate of complete elimination of pain , lower levels of relapse at 6- and 12-month follow-up , and lower levels of interference with their activities as a result of pain and parents reported a higher level of satisfaction with the treatment than children receiving SPC . After controlling for pretreatment levels of pain , children 's active self-coping and mothers ' caregiving strategies were significant independent predictors of pain behavior at posttreatment Objectives : We evaluated the efficacy of cognitive-behavioral family intervention in the treatment of crises of pain in children with nonorganic recurrent abdominal pain ( RAP ) and the thresholds of pain for 17 body surface areas in these children . Methods : A r and omized clinical trial was undertaken with 32 children between the ages of 5.1 and 13.9 years with nonorganic RAP . A group of 15 patients , aged 9.9 ± 2.2 years ( 11 girls ) , received st and ard pediatric care and cognitive-behavioral family intervention for treatment of pain crises . The control group of 17 children , aged 8.4 ± 2.0 years ( 11 girls ) , received only st and ard pediatric care . These procedures were undertaken by general pediatricians over 4 monthly sessions . An analog visual scale was used to measure the frequency and intensity of the pain crises per month and a mechanical pressure algometer for the measurement of pain threshold . Results : The median frequency of pain crises per month reported by patients at the 3 monthly cognitive-behavioral family intervention sessions was 15 , 5 , 2 and 2 , respectively . In contrast , the median frequency for pain crises per month reported by the control group was 12 , 8 , 10 and 8 , respectively . The difference between the intervention group and the controls was statistically significant for frequency of pain at the second , third and fourth visits . There was no statistical difference for intensity of pain or for measured pain thresholds between the control and the intervention group . Conclusions : The cognitive-behavioral family intervention reduced the frequency of pain crises of children with nonorganic RAP . This successful intervention was carried out by the intervention of general pediatricians Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND & AIMS There are no prospect i ve , multicenter , double-blind , placebo-controlled , r and omized pharmacologic trials for the treatment of pain-predominant functional gastrointestinal disorders in children . The aim of this study was to evaluate the efficacy of amitriptyline in children with pain-predominant functional gastrointestinal disorders . METHODS In this multicenter placebo-controlled trial , children with irritable bowel syndrome , functional abdominal pain , or functional dyspepsia were r and omized to 4 weeks of placebo or amitriptyline ( 10 mg/d , weight < 35 kg ; 20 mg/d , weight > 35 kg ) . Assessment of gastrointestinal symptoms , psychological traits , and daily activities occurred before and after intervention . Pain was assessed daily with self-report diaries . The primary outcome was overall response to treatment ( child 's assessment of pain relief and sense of improvement ) . Secondary outcomes were effect on psychosocial traits and daily functioning . RESULTS Ninety children were enrolled , and 83 completed the study ( placebo , 40 children [ 30 girls ] ; drug , 43 children [ 35 girls ] ) . A total of 63 % of patients reported feeling better and 5 % feeling worse in the amitriptyline arm compared with 57.5 % feeling better and 2.5 % feeling worse in the placebo arm ( P = .63 ) . Pain relief was excellent in 7 % and good in 38 % of children receiving placebo compared with excellent in 15 % and good in 35 % of children treated with amitriptyline ( P = .85 ) . Logistic regression analysis of those reporting excellent or good response versus fair , poor , or failed response showed no difference between amitriptyline and placebo ( P = .83 ) . Children who had more severe pain at baseline in both groups ( P = .0065 ) had worse outcome .  Amitriptyline  reduced anxiety scores ( P < .0001 ) . CONCLUSIONS Both amitriptyline and placebo were associated with excellent therapeutic response . There was no significant difference between amitriptyline and placebo after 4 weeks of treatment . Patients with mild to moderate intensity of pain responded better to treatment OBJECTIVE To determine whether a brief intervention for children with functional abdominal pain and their parents ' responses to their child 's pain result ed in improved coping 12 months later . DESIGN Prospect i ve , r and omized , longitudinal study . SETTING Families were recruited during a 4-year period in Seattle , Washington , and Morristown , New Jersey . PARTICIPANTS Two hundred children with persistent functional abdominal pain and their parents . INTERVENTIONS A 3-session social learning and cognitive behavioral therapy intervention or an education and support intervention . MAIN OUTCOME MEASURES Child symptoms and pain-coping responses were monitored using st and ard instruments , as was parental response to child pain behavior . Data were collected at baseline and after treatment ( 1 week and 3 , 6 , and 12 months after treatment ) . This article reports the 12-month data . RESULTS Relative to children in the education and support group , children in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month follow-up decreases in gastrointestinal symptom severity ( estimated mean difference , -0.36 ; 95 % CI , -0.63 to -0.01 ) and greater improvements in pain-coping responses ( estimated mean difference , 0.61 ; 95 % CI , 0.26 to 1.02 ) . Relative to parents in the education and support group , parents in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month decreases in solicitous responses to their child 's symptoms ( estimated mean difference , -0.22 ; 95 % CI , -0.42 to -0.03 ) and greater decreases in maladaptive beliefs regarding their child 's pain ( estimated mean difference , -0.36 ; 95 % CI , -0.59 to -0.13 ) . CONCLUSIONS Results suggest long-term efficacy of a brief intervention to reduce parental solicitousness and increase coping skills . This strategy may be a viable alternative for children with functional abdominal pain . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00494260 Background Because of the paucity of effective evidence -based therapies for children with recurrent abdominal pain , we evaluated the therapeutic effect of guided imagery , a well-studied self-regulation technique . Methods 22 children , aged 5 – 18 years , were r and omized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation . Both groups had 4-weekly sessions with a therapist . Children reported the numbers of days with pain , the pain intensity , and missed activities due to abdominal pain using 
    Output:
    
Functional disability was not significantly decreased after yoga compared with a wait-list approach .
: Although high- quality studies are lacking , some evidence shows efficacy of hypnotherapy , cognitive behavioral therapy , and probiotics ( LGG and VSL#3 ) in pediatric AP-FGIDs .