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Treatment of chronic recurrent abdominal pain: laparoscopy or hypnosis?
Offer Galili1, Ron Shaoul, Jorge Mogilner
1Department of General Surgery, Bnei-Zion Medical Center, Haifa, Israel.
Insights
Hypnotherapy effectively resolved functional chronic recurrent abdominal pain (FCRAP) in most children. This study supports hypnosis as a valuable biobehavioral treatment for FCRAP in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Behavioral Medicine
- Pain Management
Background:
- Functional chronic recurrent abdominal pain (FCRAP) affects 15-30% of children, posing diagnostic and treatment challenges.
- Evidence for dietary, medical, and surgical treatments is inconclusive, though cognitive-behavioral therapy shows promise.
- Understanding neural-pain pathways has led to behavioral strategies, but hypnotherapy is underutilized for FCRAP.
Purpose of the Study:
- To summarize clinical experience using hypnosis as a preferred treatment for FCRAP in children.
- To evaluate the efficacy and safety of hypnotherapy for pediatric FCRAP.
Main Methods:
- Twenty pediatric patients meeting FCRAP criteria were identified.
- Seventeen patients underwent a single session of hypnosis or imagery.
- Families were offered hypnosis, with 3 refusing participation.
Main Results:
- A nonorganic etiology for pain was identified in all cases.
- Clinical symptoms resolved in 14 out of 17 treated adolescents.
- Hypnosis was ineffective in 3 cases, potentially due to secondary gain; no side effects were reported.
Conclusions:
- Hypnotherapy, while common for acute pediatric pain, is underused for FCRAP.
- The study strongly supports integrating hypnosis into a biobehavioral approach for managing pediatric FCRAP.
Objective:
Functional chronic recurrent abdominal pain (FCRAP) is long lasting, intermittent, or constant pain affecting 15-30% of children ages 4-18 and presents a diagnostic and treatment challenge to the physician. The predictive value of diagnostic tests is questionable, and studies of the treatment of chronic abdominal pain show inconclusive evidence regarding diet regimens as well as medical and surgical treatments. However, there is evidence that cognitive-behavioral therapy may be useful in improving pain and disability outcome. Increasing the understanding of the neural-pain pathways and research in cognitive modulation of pain led to the application of behavioral strategies in children with FCRAP with variable success. However, the use of hypnotherapy in children with recurrent abdominal pain is not common. During the last 3 years, we have implemented hypnosis as the preferred treatment for patients with FCRAP. In the current study, we aimed to summarize our experience with hypnosis for the treatment of FCRAP in children.
Patients And Methods:
Twenty patients who met the criteria for FCRAP were candidates for hypnosis. Hypnosis or imagery was offered to the families, of whom 3 refused. Seventeen patients underwent just one single session of hypnosis.
Results:
A possible nonorganic etiology for the abdominal pain was revealed in all cases. In 14 adolescents, all clinical symptoms resolved. Hypnosis was not effective in 3 cases, in whom secondary gain was probably responsible for their symptoms. No side effects have been noted during and after the study. Follow-up was available for a period of 4-24 months.
Conclusions:
Although effective in the management of acute pain and distress in pediatric cancer patients, the use of hypnotherapy in children with FCRAP is not a common practice. The current study highly supports the use of hypnosis as a part of the biobehavioral approach for this dilemma.
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