Is hypnotherapy effective for pediatric functional abdominal pain or IBS?

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Abstract

BACKGROUND

Studies in adults have shown that gut-directed hypnotherapy can improve symptoms of IBS or functional dyspepsia, but it is not known whether this treatment is effective in children.

OBJECTIVE

To compare the efficacy of gut-directed hypnotherapy with that of standard medical therapy (SMT) in children with long-term IBS or functional abdominal pain (FAP).

DESIGN AND INTERVENTION

From October 2002 to June 2005, this randomized controlled trial recruited children aged 8-18 years who had either FAP or IBS (according to the Rome II criteria) of at least 12 months duration and who had been treated previously with SMT or psychological therapies without success. Participants were randomly allocated to 3 months of treatment with either gut-directed hypnotherapy, which entailed six 50 min sessions of Manchester protocol therapy with a nurse of 4 years training and 15 years experience, or SMT, which comprised six 30 min supportive therapy sessions and standard care using education, dietary advice, extra fiber, and pain medication or PPIs. Patients kept a daily diary card on which they individually scored pain intensity and pain frequency; daily scores were totaled over 7 days to give a weekly pain intensity score (PIS) and pain frequency score (PFS). Frequency of associated gut symptoms (e.g. nausea or loss of appetite) were scored on a weekly basis. Scores were assessed at 1, 4, 8 and 12 weeks, and at 6 and 12 months after therapy.

OUTCOME MEASURES

The primary outcome measure was the proportion of patients with complete clinical remission of abdominal pain (defined as a greater than 80% decrease in PIS and PFS).

RESULTS

A total of 53 children were included in the study (27 and 25 patients received hypnotherapy and SMT, respectively). A greater proportion of patients in the hypnotherapy group achieved clinical remission than in the SMT group; at the end of treatment 59% of patients in the hypnotherapy group reached complete clinical remission compared with 12% of patients in the SMT group (P<0.001), and 85% and 25%, respectively achieved complete clinical remission at 12 months' follow up (P<0.001). Mean PIS was significantly less at 12 months' follow-up than at baseline in both the hypnotherapy group and the SMT group (13.5 reduced to 1.3, P<0.001 and 14.1 reduced to 8.0, P = 0.002, respectively), as was mean PFS (13.5 reduced to 1.1, P<0.001 and 14.4 reduced to 9.3, P = 0.007, respectively). However, the decreases in PIS and PFS were significantly greater in the hypnotherapy group than in the SMT group (P<0.002 and P<0.001, respectively). Associated symptom scores decreased significantly in both groups, but there was no significant difference between hypnotherapy and SMT. Response to therapy was influenced by age-children <14 years of age showed better treatment response than did older patients up until 6 months after therapy-but not by type of functional gastrointestinal disorder.

CONCLUSION

Gut-directed hypnotherapy provides long- term relief of pain and symptoms in pediatric patients with persistent refractory IBS or FAP

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