Hypnotherapy and talking therapies are the “best” treatments for children suffering from long-term stomach pain, according to new research.
The findings come from a new study, the largest of its kind, which analysed various treatments for chronic stomach pain in children, including irritable bowel syndrome, abdominal migraines, and unexplained pain.
These conditions affect up to 12 per cent of children and cause “chronic, debilitating pain” in as many as 300 million children globally.
Researchers examined 91 studies involving more than 7,200 children aged four to 18, which evaluated a range of treatments, including dietary changes, medication, probiotics, and psychosocial treatments such as cognitive behavioural therapy (CBT), also known as talking therapy, and hypnotherapy.
The research team, led by experts at the University of Central Lancashire, concluded that “hypnotherapy and CBT show moderate certainty for treatment efficacy with clinically relevant effect sizes” and are calling for greater access to these therapies within the UK, urging a shift away from the “prejudice” often associated with psychosocial treatments for abdominal pain.
Hypnotherapy is 68 per cent more successful and CBT 35 per cent more successful than taking no action, the university said, but “no conclusions can be made about the other therapies and treatment success due to very low evidence certainty”, the authors wrote in the journal Lancet Child and Adolescent Health.
Study lead author Professor Morris Gordon, from the University of Central Lancashire’s School of Medicine, said that “almost one in 20 of every single children’s appointment in a hospital outpatients will be explicitly for this problem compared to all other problems” in the UK.
“So it’s a huge burden, not just on the NHS, but, more importantly, for the kids and of course their families – they can’t go to school, they can’t function… You’ve got someone who was a high-flying gymnast or had a really good hobby – BMXing, and you name it – I’ve heard both of those examples in the last couple of years, and it’s gone. It’s done.
“We have found that hypnotherapy and CBT have the best evidence of providing successful treatment and to reduce pain.
“Other therapies have evidence of an effect, but, due to systematic concerns with the findings, no conclusions can be drawn at the moment.”
Professor Gordon, who carried out the study with colleagues from the Netherlands and Florida in the US, said a new guideline for treating abdominal pain in children has been created off the back of the study.
“Currently, there are no guidelines available for medical practitioners, so treatment methods are sporadic with no real evidence to underpin them,” he said.
“One GP may prescribe probiotics while another may prescribe pain medication, whereas others prefer a diet or a psychological treatment.
“This analysis provides, for the first time, an accurate way of grading the success rate of treatments.”
He said there is often an expectation for “medicalisation” and there is a “prejudice” against psychosocial therapies.
“All that matters is the right outcome for the child and the family,” he said.
“It is important to point out that we’re not suggesting the condition is psychological because we don’t know of a single definite cause in these cases. What we’re suggesting is the best way to manage it, taking into consideration the frequency and severity of the pain, the way they impact a patient’s life, and the side-effects of treatments.
“Think about it in the same way we don’t take paracetamol to cure a cold but to manage the pain. You can’t stop the music playing but you can turn down the volume.”
Meanwhile, Professor Gordon said hypnotherapy and CBT are difficult to access to treat abdominal pain and called for more to be done to make them more widely available.
“So what we’ve essentially got here is a top therapy in terms of safety, relatively easy to offer with good acceptability and tolerability… and yet, despite all of that, they’re not being used,” he added.
Professor Marc Benninga, a paediatric gastroenterologist from Emma Children’s Hospital in Amsterdam who worked on the project, called for more trials to assess the other treatments for abdominal pain in children.
“This study highlights the low quality of the scientific research that has been performed to date in a very common condition as abdominal pain,” he said.
