Effectiveness of hypnotherapy for paediatric abdominal pain in primary care: a randomised controlled trial.

The short version

This randomised controlled trial with 152 Dutch children explored whether home-based guided hypnotherapy, added to usual care from a general practitioner (GP), helps children with functional abdominal pain (recurring stomach pain with no underlying disease found) or irritable bowel syndrome (IBS, abdominal pain linked to bowel habit changes). Both conditions are disorders of gut-brain interaction, meaning the gut and the nervous system influence one another, and in children they are linked with anxiety, school absence and lower quality of life. Hypnotherapy is a state of focused attention in which therapeutic suggestions are used to influence sensation, emotion and thought. It is already available in secondary care, but its effect in primary care had not been tested. Children aged 7 to 17 with a GP diagnosis were randomly assigned to usual care alone (education, reassurance and symptom monitoring) or usual care plus hypnotherapy. Of the 152 children, 46 came through GPs and 106 through social media; median age was 9.4 years. The hypnotherapy group listened to five audio exercises on a website, one for breathing and relaxation and four visualisation exercises, for 15 to 20 minutes on at least five days a week for three months. The main outcome was adequate relief of abdominal pain at 12 months; pain severity was rated from 0 to 10. At 12 months the main result was not statistically significant: 79.5% of the hypnotherapy group reported adequate relief versus 74.3% of the usual care group (adjusted odds ratio 1.47, 90% confidence interval 0.74 to 2.93; the interval includes no difference). Earlier, differences were larger. At 3 months 73.2% versus 56.8% reported relief (odds ratio 2.74, meaning higher odds of relief), and at 6 months 77.6% versus 58.6% (odds ratio 4.26). Pain severity scores were lower in the hypnotherapy group by 1.38 points at 6 months and 0.89 points at 12 months, but not significantly at 3 months. Pain threat beliefs were lower and more children fell asleep within 20 minutes. Anxiety, depression, quality of life and school absence were similar between groups. No adverse events were spontaneously reported, but children were not asked about them directly. The authors suggest that hypnotherapy added to usual care may bring earlier relief and lower pain at low cost, and note that relief at 12 months was high in both groups. The trial had limits: it recruited fewer children than planned, so the significance threshold was relaxed to 10%, which raises the chance of false positives. Participants and clinicians knew who received hypnotherapy, and most families preferred it, so placebo effects are possible. More than 40% of pain diary data were missing. The authors call for research on which children benefit most and on possible adverse effects.

Key findings

• Adding home-based guided hypnotherapy (listening to recorded relaxation and visualisation exercises) to usual GP care did not produce a statistically significant difference in adequate pain relief at 12 months (79.5% vs 74.3%).
• Children in the hypnotherapy group were more likely to report adequate relief earlier, at 3 months (73.2% vs 56.8%) and 6 months (77.6% vs 58.6%).
• Pain severity and pain threat beliefs (how much the child sees the pain as a danger) were lower, and more children fell asleep within 20 minutes, in the hypnotherapy group, while anxiety, depression, quality of life and school absence were similar between groups.
• The trial was smaller than planned (152 of 200 children) and used a relaxed 10% significance level, so the authors state the results should be interpreted with caution.
• No adverse events were spontaneously reported, but safety was not specifically asked about.

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