Erik Sowder, M.S., BCIAC, Anu Kotay, M.S., BCIAC, Richard Gevirtz, Ph.D., BCIAC Cassie Cannon, M.S., BCIAC

Alliant International University, San Diego, CA

The hypothesis that Recurrent Abdominal Pain (RAP) has been hypothesized to be associated with a deficit in autonomic nervous system recovery to stress and an enhanced behavioral and subjective response to pain. (Feuerstein, Barr, Francoeur, Houle, & Rafman, 1982). Most currently empirically validated treatments make use of this hypothesis to some extent. This study investigates the efficacy of a treatment protocol for RAP that focuses on autonomic balance.

Patients diagnosed with RAP were referred for Heart Rate Variability Biofeedback treatment by a pediatric gastroenterologist at Kaiser Permanente in San Diego. The subjects were seen by one of three interns that had completed a course on Biofeedback and Psychophysiological disorders and attended weekly supervision meetings with a licensed psychologist (the second author).

Autonomic regulation measures were collected in the form of peak-valley differences of Respiratory Sinus Arrhythmia (RSA) (for breaths within the .15 to .4 range). Pain severity was assessed by a VAS scale completed by the participants before and after treatment (Naliboff, Fullerton, & Mayer, 1999). RAP symptom frequency was measured by the number of episodes per week pre and post treatment. Two patients were monitored with ambulatory monitoring equipment (VivoMetrics LifeShirt).

Of forty-three patients referred to Biofeedback, thirty- six were treated. (age range of 7 to 18 years). A paired t-test analysis revealed a significant difference in pre and post self-report ratings of pain intensity (t(8)4.494, p<.001, 2= 0.49) and frequency (t(14)=4.498, p=.002, , 2=0.38).

Pre and post peak-valley differences of respiratory sinus arrhythmia (RSA) at a paced breathing rate were also analyzed with a paired t-test and found to be significant (t(6)= -3.20, p=.019, 2=0.36).

Follow-up data collected on 16 patients from a range of a one month to 2 years after treatment. Follow pain intensity and frequency were both significant compared to pre measures (t=3.810, p=.019; t=3.627, p=.007, respectively).

Fifty-six percent of contacted patients were pain-free at follow-up interview. Ambulatory data will be presented.

In conclusion, subjects with RAP were able to significantly lower their ratings of pain intensity and frequency within an average of six sessions of HRV Biofeedback administered by interns in a pediatric medical setting.