Psycho-social therapies found to be most effective treatments for unexplained abdominal pain in children

Hypnotherapy and cognitive behavioral therapy (CBT) are the most effective treatments for children suffering with unexplained abdominal pain, according to new research published today in The Lancet Child & Adolescent Health.

The findings found that hypnotherapy is 68% more successful and CBT 35% more successful than taking no action. This was compared with pharmacological treatments such as Buspirone or Tricyclics, different drugs prescribed to treat anxiety, or antispasmodic drugs, used to reduce spasmodic pain, which showed a very low level of certainty for treatment success, not allowing any conclusions to be made.

Functional abdominal pain-related disorders, commonly known as irritable bowel syndrome or functional abdominal pain not otherwise specified, are defined as pain conditions where no other underlying causes such as celiac disease or inflammatory bowel disease are found. They affect 1 in 13 children around the world, yet, despite this high figure, there are no international guidelines on the most effective treatments and their success rate.

These new findings are from a systematic review conducted by researchers at the University of Central Lancashire, Emma Children’s Hospital, Amsterdam University Medical Centers in Amsterdam, The Netherlands and Nemours Children’s Hospital in Orlando, Florida, who analyzed data from 91 research trials involving more than 7,000 children aged 4 to 18 years across 22 countries over 40 years.

The research team, led by Professor Morris Gordon from the University of Central Lancashire’s School of Medicine, used an analysis method called network meta-analysis (NMA), an advanced statistical technique that summarizes all available evidence for multiple comparisons.

This technique has never been used to analyze treatments for abdominal pain in children. It’s the first time that the efficacy and safety of all known treatment options have been assessed together to compare them fairly in terms of success rate. Previous reviews found success measured by a multitude of factors, including reductions in pain frequency, duration, intensity, severity, or a combination, so aren’t comparable.

“This work is a systematic review of all existing studies on these conditions using the most complex and highest quality methods,” said Professor Gordon.

“It allows for all treatments to be compared together, even if they weren’t studied together. We have found that hypnotherapy and CBT have the best evidence of providing successful treatment and reducing pain. Other therapies have evidence of an effect, but due to systematic concerns with the findings, no conclusions can be drawn at the moment.

“Currently, there are no guidelines available for medical practitioners, so treatment methods are sporadic with no real evidence to underpin them. One GP may prescribe probiotics while another may prescribe pain medication, whereas others prefer a diet or a psychological treatment. The truth is there is no real evidence of what approach is best, so this analysis provides, for the first time, an accurate way of grading the success rate of treatments.”

The findings from this study will be used to form the first ever official guidelines for abdominal pain in children, due to be released later this year.

Professor Marc Benninga, a pediatric gastroenterologist from Emma Children’s Hospital who worked on the project, said, “This study also highlights the low quality of the scientific research that has been performed to date in a very common condition as abdominal pain. National or even international collaboration is necessary to perform high-quality randomized controlled trials to provide adequate information about the different treatments for children with this condition.

“For future intervention trials, we recommend using homogenous outcome measures and instruments, a large sample size, and long-term follow-up.”

Pediatric gastroenterologist at Emma Children’s Hospital Merit Tabbers also contributed to the project. She said, “This evidence-based document concerning effective treatments for pediatric functional abdominal pain-related disorders can serve as guidance for clinical practice in order to facilitate shared decision-making between health care professionals, children and their caregivers.”

“Patients with functional abdominal pain disorders may struggle to find relief for their symptoms,” said Edward Mougey, a research scientist and study team member at Nemours Children’s Health, Jacksonville.

“This study synthesizes current knowledge and highlights the importance of testing new therapies in properly designed randomized clinical trials that will ultimately improve treatment options for children with these disorders.”

Professor Gordon added, “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.”