Managing chronic stomach pain in children

The Star

03-05-2025

Hypnotherapy and talking therapy are the best treatments for long-term stomach pain in children, a new study suggests.
Experts said that more needs to be done to make these therapies available for children and to tackle the 'prejudice' linked to psychosocial treatments for abdominal pain.
It comes after a new study – the largest of its kind – saw researchers analyse various treatments for chronic stomach pain, including irritable bowel syndrome (IBS), abdominal migraines and unexplained pain.
These conditions affect up to 12% of children and it is estimated they cause 'chronic, debilitating pain' in 300 million children around the world.
Promising results
The researchers examined 91 studies involving more than 7,200 children aged four to 18 years.
The studies assessed dietary treatments; medicines; probiotics; psychosocial treatments, including cognitive behavioural therapy (CBT), also known as talking therapy; and hypnotherapy.
The team of academics, led by experts at the University of Central Lancashire in Britain, found that 'hypnotherapy and CBT show moderate certainty for treatment efficacy with clinically relevant effect sizes'.
Hypnotherapy is 68% more successful and CBT 35% more successful than taking no action, the university said.
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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 and consultant paediatrician Professor Dr Morris Gordon said: 'In Britain, 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.
'So it's a huge burden, not just on the NHS [National Health Service], 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.'
He went on: '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.'
A treatment guideline
Prof Gordon, who carried out the study with colleagues from the Netherlands and Florida in the United States, said that a new guideline for treating abdominal pain in children has been created off the back of the study.
'Currently, there no guidelines available for medical practitioners, so treatment methods are sporadic with no real evidence to underpin them,' he said.
'One GP [general practitioner] 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 added that there is often an expectation for 'medicalisation' and a 'prejudice' against psychosocial therapies.
'All that matters is the right outcome for the child and the family,' he said.
He went on: '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, he said that 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 said.
Prof Dr Marc Benninga, a paediatric gastroenterologist from Emma Children's Hospital in Amsterdam who also worked on the study, called for more trials to assess the other treatment methods 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. – PA Media/dpa