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Functional abdominal pain (FAP) and irritable bowel syndrome affect about 20% of children. Hypnotherapy has been used for these conditions: It is a relaxing, nonjudgmental treatment in which a hypnotherapist induces a hypnotic state and then guides the patient with suggestions for changes in experiences, perceptions, emotions, thoughts, and behaviors related to symptoms. Researchers systematically reviewed recent studies of gut-directed hypnotherapy in children with these conditions, and identified three randomized controlled trials of adequate methodological quality involving 108 patients (age range, 5–18 years). Meta-analysis was not possible because of heterogeneity of symptom duration, intervention specifics, and outcome measures. However, outcome assessments were not biased and follow-up was good.
Two studies in 74 children with chronic (>3 months) abdominal symptoms compared the efficacy of 1 to 3 months of hypnotherapist-guided treatment (1–2 times/week) with that of standard care and supportive therapy. Hypnotherapy was associated with significantly lower short-term measures of pain in both trials and a significantly higher 1-year remission rate in the larger of the two trials (85% vs. 25%). The third study examined the efficacy of hypnotherapy induced by guided imagery through self-exercises on audio CD in 35 children with chronic activity-disrupting FAP. After 2 months, children in the guided-imagery group had a significantly greater treatment response rate (≥50% reduction in pain score) than the control group (63% vs. 27%), and significantly improved quality-of-life scores. No side effects were reported in any study.
Rutten JM et al. Gut-directed hypnotherapy for functional abdominal pain or irritable bowel syndrome in children: A systematic review. Arch Dis Child 2013 Apr; 98:252. (http://dx.doi.org/10.1136/archdischild-2012-302906)
Whorwell PJ. Hypnotherapy: First line treatment for children with irritable bowel syndrome? Arch Dis Child 2013 Apr; 98:243. (http://dx.doi.org/10.1136/archdischild-2012-303178)
Comment
Randomized, controlled trials of hypnotherapy are limited because blinding is not possible. However, this systematic review of well-done studies suggests that hypnotherapy can have substantial long-term benefit when compared with standard care and supportive therapy. Hypnotherapy might work through physiologic changes as well as reductions in psychological stress and the subjective experience of abdominal pain. An editorialist advocates early intervention for functional gastrointestinal disorders before unhealthy patterns of illness behavior become entrenched. Key practice-related questions include how to find qualified pediatric hypnotherapists and how hypnotherapy will be paid? Training primary care clinicians to do a modified form of hypnotherapy could be one solution to the first question (see National Pediatric Hypnosis Training Institute).