Hypnotherapy in Children With Abdominal Pain or IBS
Hypnotherapy in Children With Abdominal Pain or IBS
OBJECTIVES: We previously showed that gut-directed hypnotherapy (HT) is highly effective in the treatment of children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). Aim of this follow-up study was to investigate the long-term effects of HT vs. standard medical treatment plus supportive therapy (SMT).
METHODS: All 52 participants of our previous randomized controlled trial (RCT) were invited to complete a standardized abdominal pain diary, on which pain frequency and pain intensity were scored. Furthermore, the Children's Somatization Inventory (CSI) and a general quality of life (QOL) questionnaire were filled out. Clinical remission was defined as >80% improvement in pain scores compared with baseline.
RESULTS: All 27 HT patients and 22 out of 25 SMT patients participated in this study. Two patients of the SMT group were lost to follow-up and one refused to participate. After a mean duration of 4.8 years follow-up (3.4–6.7), HT was still highly superior to conventional therapy with 68 vs. 20% of the patients in remission after treatment (P=0.005). Pain intensity and pain frequency scores at follow-up were 2.8 and 2.3, respectively, in the HT group compared with 7.3 and 7.1 in the SMT group (P<0.01). Also, somatization scores were lower in the HT group (15.2 vs. 22.8; P=0.04). No differences were found in QOL, doctors' visits, and missed days of school or work between the two groups.
CONCLUSIONS: The beneficial effects of gut-directed HT are long lasting in children with FAP or IBS with two thirds still in remission almost 5 years after treatment, making it a highly valuable therapeutic option.
Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are the common disorders in the pediatric population. Both conditions typically present with chronic or recurrent abdominal pain and, in case of IBS, with a disturbed defecation pattern, ranging from lumpy or hard stools to loose, watery diarrhea or both. Estimates on the prevalence range from 0.3 to 19%, with the highest prevalence between 4 and 6 years of age and early adolescence. FAP and IBS in children and adolescents have been associated with significant impairment in self-reported quality of life (QOL) scores, increased rates of school absenteeism, and a higher risk for depressive symptoms and social isolation. Many children and adolescents with mild symptoms of FAP or IBS will improve with physician reassurance and time, but long-term follow-up studies have shown that a significant number of patients continue to experience symptoms into adulthood.
The management of patients with persistent or severe illness often presents a challenge for pediatricians and pediatric gastroenterologists. To date, scientific data are lacking to support the routine use of pharmacological agents, dietary interventions, such as extra fibers or probiotics. Cognitive-behavioral therapy is an effective treatment option in children with recurrent or chronic abdominal pain and for many pediatricians; it is the therapy of choice if standard medical care has failed. However, parents of children with FAP or IBS can be reluctant in accepting the existence of psychosocial influences on their child's symptoms and often refuse to engage with psychological services. Between 2002 and 2005, we conducted a randomized controlled trial (RCT) to study the effect of gut-directed hypnotherapy (HT) in 52 pediatric patients with long-lasting FAP or IBS. HT was introduced to parents and children as a method influencing and reducing pain through the brain and was, therefore, by most parents not perceived as a psychological intervention. At 1 year follow-up, successful treatment was accomplished in 85% of the HT group compared with only 25% of the group, receiving standard medical treatment plus supportive therapy (SMT).
Aim of the present study was to investigate and compare the long-term effects (>4 years) of HT and SMT in children with FAP or IBS in terms of symptom improvement, medication use, school or work absenteeism, and QOL. For this purpose, all participants of the original study were contacted and asked to fill out abdominal pain diaries.
Non-gastrointestinal (non-GI) somatic complaints like headache, chronic fatigue or joint pain are common in children and adults with functional GI disorders, and the common overlap with other functional disorders is well recognized. Our gut-directed HT protocol addresses mainly abdominal discomfort and a possible side effect of our treatment could be a shift from abdominal complaints toward other functional somatic symptoms. We therefore also inquired our patients about the presence of extraintestinal problems.
Abstract and Introduction
Abstract
OBJECTIVES: We previously showed that gut-directed hypnotherapy (HT) is highly effective in the treatment of children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). Aim of this follow-up study was to investigate the long-term effects of HT vs. standard medical treatment plus supportive therapy (SMT).
METHODS: All 52 participants of our previous randomized controlled trial (RCT) were invited to complete a standardized abdominal pain diary, on which pain frequency and pain intensity were scored. Furthermore, the Children's Somatization Inventory (CSI) and a general quality of life (QOL) questionnaire were filled out. Clinical remission was defined as >80% improvement in pain scores compared with baseline.
RESULTS: All 27 HT patients and 22 out of 25 SMT patients participated in this study. Two patients of the SMT group were lost to follow-up and one refused to participate. After a mean duration of 4.8 years follow-up (3.4–6.7), HT was still highly superior to conventional therapy with 68 vs. 20% of the patients in remission after treatment (P=0.005). Pain intensity and pain frequency scores at follow-up were 2.8 and 2.3, respectively, in the HT group compared with 7.3 and 7.1 in the SMT group (P<0.01). Also, somatization scores were lower in the HT group (15.2 vs. 22.8; P=0.04). No differences were found in QOL, doctors' visits, and missed days of school or work between the two groups.
CONCLUSIONS: The beneficial effects of gut-directed HT are long lasting in children with FAP or IBS with two thirds still in remission almost 5 years after treatment, making it a highly valuable therapeutic option.
Introduction
Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are the common disorders in the pediatric population. Both conditions typically present with chronic or recurrent abdominal pain and, in case of IBS, with a disturbed defecation pattern, ranging from lumpy or hard stools to loose, watery diarrhea or both. Estimates on the prevalence range from 0.3 to 19%, with the highest prevalence between 4 and 6 years of age and early adolescence. FAP and IBS in children and adolescents have been associated with significant impairment in self-reported quality of life (QOL) scores, increased rates of school absenteeism, and a higher risk for depressive symptoms and social isolation. Many children and adolescents with mild symptoms of FAP or IBS will improve with physician reassurance and time, but long-term follow-up studies have shown that a significant number of patients continue to experience symptoms into adulthood.
The management of patients with persistent or severe illness often presents a challenge for pediatricians and pediatric gastroenterologists. To date, scientific data are lacking to support the routine use of pharmacological agents, dietary interventions, such as extra fibers or probiotics. Cognitive-behavioral therapy is an effective treatment option in children with recurrent or chronic abdominal pain and for many pediatricians; it is the therapy of choice if standard medical care has failed. However, parents of children with FAP or IBS can be reluctant in accepting the existence of psychosocial influences on their child's symptoms and often refuse to engage with psychological services. Between 2002 and 2005, we conducted a randomized controlled trial (RCT) to study the effect of gut-directed hypnotherapy (HT) in 52 pediatric patients with long-lasting FAP or IBS. HT was introduced to parents and children as a method influencing and reducing pain through the brain and was, therefore, by most parents not perceived as a psychological intervention. At 1 year follow-up, successful treatment was accomplished in 85% of the HT group compared with only 25% of the group, receiving standard medical treatment plus supportive therapy (SMT).
Aim of the present study was to investigate and compare the long-term effects (>4 years) of HT and SMT in children with FAP or IBS in terms of symptom improvement, medication use, school or work absenteeism, and QOL. For this purpose, all participants of the original study were contacted and asked to fill out abdominal pain diaries.
Non-gastrointestinal (non-GI) somatic complaints like headache, chronic fatigue or joint pain are common in children and adults with functional GI disorders, and the common overlap with other functional disorders is well recognized. Our gut-directed HT protocol addresses mainly abdominal discomfort and a possible side effect of our treatment could be a shift from abdominal complaints toward other functional somatic symptoms. We therefore also inquired our patients about the presence of extraintestinal problems.
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