Clinical Hypnosis for Pediatric Gastrointestinal Disorders: A Practical Guide for Clinicians

Functional abdominal pain disorders (FAPDs) are common in the pediatric population and are associated with a significant reduction in quality of life. Bidirectional communication of the brain-gut axis plays an important role in pain generation and perception in FAPDs. There is a paucity of data on the best approach to treat this group of disorders, with no Food and Drug Administration (FDA)-approved drugs and scarce research to substantiate the use of most medications. Use of hypnosis in pediatric FAPDs is supported by evidence and has long-term benefits of up to at least 5 years beyond completion of treatment, highlighting the importance of incorporating this therapy into the care of these patients. The mechanisms by which clinical hypnosis is beneficial in the treatment of FAPDs is not completely understood, but there is growing evidence that it impacts functioning of the brain-gut axis, potentially through influence on central pain processing, visceral sensitivity, and motility. The lack of side effects or potential for significant harm and low cost makes it an attractive option compared to pharmacologic therapies. This review addresses current barriers to clinical hypnosis including misconceptions among patients and families, lack of trained clinicians, and questions around insurance reimbursement. The recent use of telemedicine and delivery of hypnosis via audio-visual modalities allow more patients to benefit from this treatment. As the evidence base for hypnosis grows, acceptance and training will likely increase as well. Further research is needed to understand how hypnosis works and to develop tools that predict who is most likely to respond to hypnosis. Studies on cost-effectiveness in comparing hypnosis to other therapies for FAPDs will increase evidence for appropriate healthcare utilization. Because hypnosis has applications beyond pain and is child-friendly with minimal to no risk, hypnosis could be an important therapeutic tool in the wider pediatric gastrointestinal population.

[1]  J. Bovendeert,et al.  Long-Term Follow-up of Individual Therapist Delivered and Standardized Hypnotherapy Recordings in Pediatric Irritable Bowel Syndrome or Functional Abdominal Pain , 2022, Journal of pediatric gastroenterology and nutrition.

[2]  M. Benninga,et al.  Skills or Pills - Randomized trial comparing Hypnotherapy to Medical Treatment in children with Functional Nausea. , 2021, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[3]  J. Hugot,et al.  Functional abdominal pain disorders and patient- and parent- reported outcomes in children with inflammatory bowel disease in remission. , 2021, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[4]  M. Karkhaneh,et al.  Adverse Events of Mind-Body Interventions in Children: A Systematic Review , 2021, Children.

[5]  G. Elkins,et al.  Therapeutic Use of the Elkins Hypnotizability Scale: A Feasibility Study , 2021, The International journal of clinical and experimental hypnosis.

[6]  D. Spiegel,et al.  The Hypnotic Induction Profile (HIP) in Clinical Practice and Research , 2021, The International journal of clinical and experimental hypnosis.

[7]  J. Slaughter,et al.  Clinical Hypnosis in Pediatric Crohn's Disease: A Randomized Controlled Pilot Study. , 2020, Journal of pediatric gastroenterology and nutrition.

[8]  O. Palsson,et al.  Hypnosis and Cognitive Behavioral Therapies for the Management of Gastrointestinal Disorders , 2020, Current Gastroenterology Reports.

[9]  O. Palsson,et al.  A National Survey of Clinical Hypnosis Views and Experiences of the Adult Population in the United States , 2019, The International journal of clinical and experimental hypnosis.

[10]  Deborah I Thompson,et al.  Maternal and Child Acceptability of a Proposed Guided Imagery Therapy Mobile App Designed to Treat Functional Abdominal Pain Disorders in Children: Mixed-Methods Predevelopment Formative Research , 2018, JMIR pediatrics and parenting.

[11]  C. Di Lorenzo,et al.  Prevalence of Pediatric Functional Gastrointestinal Disorders Utilizing the Rome IV Criteria , 2018, The Journal of pediatrics.

[12]  M. Dijkgraaf,et al.  Home-Based Hypnotherapy Self-exercises vs Individual Hypnotherapy With a Therapist for Treatment of Pediatric Irritable Bowel Syndrome, Functional Abdominal Pain, or Functional Abdominal Pain Syndrome: A Randomized Clinical Trial , 2017, JAMA pediatrics.

[13]  C. Breuner,et al.  Clinical Hypnosis, an Effective Mind–Body Modality for Adolescents with Behavioral and Physical Complaints , 2017, Children.

[14]  A. Karpinski,et al.  Functional Gastrointestinal Disorders Dominate Pediatric Gastroenterology Outpatient Practice , 2016, Journal of pediatric gastroenterology and nutrition.

[15]  D. Drossman.  Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. , 2016, Gastroenterology.

[16]  A. Vanhaudenhuyse,et al.  Efficacy and cost‐effectiveness: A study of different treatment approaches in a tertiary pain centre , 2015, European journal of pain.

[17]  O. Palsson,et al.  Hypnosis and Guided Imagery Treatment for Gastrointestinal Disorders: Experience With Scripted Protocols Developed at the University of North Carolina , 2015, The American journal of clinical hypnosis.

[18]  A. Lembo,et al.  Inpatient burden of childhood functional GI disorders in the USA: an analysis of national trends in the USA from 1997 to 2009 , 2015, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[19]  J. Varni,et al.  Health-related quality of life in pediatric patients with functional and organic gastrointestinal diseases. , 2015, The Journal of pediatrics.

[20]  D. Kohen,et al.  Clinical Hypnosis with Children and Adolescents—What? Why? How?: Origins, Applications, and Efficacy , 2014, Children.

[21]  M. Jensen,et al.  Hypnotic approaches for chronic pain management: clinical implications of recent research findings. , 2014, The American psychologist.

[22]  P. Lundberg,et al.  Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome , 2013, Alimentary pharmacology & therapeutics.

[23]  M. Hautzinger,et al.  Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial , 2013, European Journal of Pediatrics.

[24]  J. Ballenger.  Long-Term Follow-Up of Gut-Directed Hypnotherapy vs. Standard Care in Children With Functional Abdominal Pain or Irritable Bowel Syndrome , 2013 .

[25]  G. Montgomery,et al.  The Impact of Hypnotic Suggestibility In Clinical Care Settings , 2011, The International journal of clinical and experimental hypnosis.

[26]  M. Saps,et al.  A Million-dollar Work-up for Abdominal Pain: Is It Worth It? , 2010, Journal of pediatric gastroenterology and nutrition.

[27]  M. Benninga,et al.  No Change in Rectal Sensitivity After Gut-Directed Hypnotherapy in Children With Functional Abdominal Pain or Irritable Bowel Syndrome , 2010, The American Journal of Gastroenterology.

[28]  W. Whitehead,et al.  Audio-Recorded Guided Imagery Treatment Reduces Functional Abdominal Pain in Children: A Pilot Study , 2009, Pediatrics.

[29]  M. Benninga,et al.  Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. , 2007, Gastroenterology.

[30]  Sari A Acra,et al.  Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial , 2006, BMC pediatrics.

[31]  P. White,et al.  Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain. , 2006, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[32]  F. De Iorio,et al.  Prokinetic effect of gut‐oriented hypnosis on gastric emptying , 2006, Alimentary pharmacology & therapeutics.

[33]  E. Björnsson,et al.  Treatment With Hypnotherapy Reduces the Sensory and Motor Component of the Gastrocolonic Response in Irritable Bowel Syndrome , 2004, Psychosomatic medicine.

[34]  P. Whorwell,et al.  Gut‐focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome , 2003, Alimentary pharmacology & therapeutics.

[35]  S. Lynn,et al.  The Role of Hypnotizability Assessment in Treatment , 2002, The American journal of clinical hypnosis.

[36]  S. Derbyshire,et al.  Cerebral Activation in Patients With Irritable Bowel Syndrome and Control Subjects During Rectosigmoid Stimulation , 2001, Psychosomatic medicine.

[37]  R. Kessler,et al.  Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention. , 2000, Gastroenterology.

[38]  P. Whorwell,et al.  Physiological effects of emotion: assessment via hypnosis , 1992, The Lancet.

[39]  L. Beaugerie,et al.  Modulation of orocaecal transit time by hypnosis. , 1991, Gut.

[40]  P. Whorwell,et al.  Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. , 1990, Gut.

[41]  D. Spiegel,et al.  Modulation of gastric acid secretion by hypnosis. , 1989, Gastroenterology.

[42]  H. Benson.  Hypnosis and the relaxation response. , 1989, Gastroenterology.

[43]  E. Hilgard,et al.  On the degree of stability of measured hypnotizability over a 25-year period. , 1989, Journal of personality and social psychology.

[44]  W. Tryon,et al.  The relationship between the Hypnotic Induction Profile and the Stanford Hypnotic Susceptibility Scale, Form C: a replication. , 1980, The American journal of clinical hypnosis.