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

Ilse N Ganzevoort; Marjolein Y Berger; Michiel R de Boer; Marc A Benninga; Arine M Vlieger; Gea A Holtman

doi:10.3399/BJGP.2025.0459

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Figure 1. Flowchart of participants. ^aData from participants to date of withdrawal were used for secondary outcome analyses, but primary outcome data were missing. ^bChildren with missing follow-up data for all timepoints were not included in analyses for secondary outcomes. Bought hypnotherapy exercises = number of children who had independently purchased and downloaded hypnotherapy exercises from an external website.

Tables

Figures

View popup

Box 1. Details of outcomes

Outcome	Instrument	Score calculation and interpretation
Pain severity	Numerical rating scale-11 (NRS-11)	Severity of pain and/or discomfort in the past week is rated on an 11-point NRS scale from 0 (no pain) to 10 (worst pain). Higher scores indicate higher pain severity
Pain intensity and frequency	Abdominal pain diary of 7 consecutive days	Pain intensity score: an affective facial pain scale consists of nine faces, ranging from no pain at all (score 0) to the most severe pain (score 3). The pain intensity score is the sum score of 7 days (range 0–21) Pain frequency score: pain duration is measured in categories, ranging from no pain (score 0), 1–30 min (score 1), 31–120 min (score 2), to >120 min (score 3). The pain frequency score is the sum score of 7 days (range 0–21)
Health-related Quality of Life (HR-QoL)	KIDSCREEN-52 questionnaire	Fifty-two items are covered in 10 HR-QoL dimensions: physical wellbeing, psychological wellbeing, moods and emotions, self-perception, autonomy, relations with parents and home life, social support and peers, school environment, social acceptance (bullying), and financial resources. Each item is rated on a five-point Likert scale. Rasch scores are computed for each dimension, and are then converted to T-value norms with a mean of 50 (standard deviation of 10). Higher T-values indicate a better HR-QoL and wellbeing
Pain beliefs	Pain Beliefs Questionnaire (PBQ)	A total of 32 items consists of a pain belief statement that range from not true at all (score 0) to very true (score 4). Three subscales are the sum of their items: pain threat (20 items), problem-focused coping efficacy (six items), and emotion-focused coping efficacy (six items). A higher score on the pain threat scale indicates stronger belief that their abdominal pain is a threat (range: 0–4). Higher scores on both coping subscales indicate stronger beliefs in their ability to cope with pain (range: 0–4)
Anxiety and depression scores	Revised Anxiety and Depression Scale-short version (RCADS-25)	This questionnaire comprises 20 items of anxiety and five items of depression disorders. Items are rated on a four-point scale from 0 (never) to 3 (always). A total score for anxiety and depression is the sum of their corresponding items. Higher scores indicate more symptoms of anxiety (range: 0–60) or depression (range: 0–15)
Somatisation	Children’s Somatisation Inventory (CSI)	Physical symptoms in the previous 2 weeks are rated on 35 items using a five-point Likert scale ranging from no problems (score 0) to a lot (score 4). A total score is the sum of all items, with higher scores indicating more somatic complaints (range: 0–140)
Sleep disturbances	Dutch Sleep Self-Report questionnaire	Three items are questioned: ‘Do you fall asleep in about 20 minutes?’ (score reversed), ‘Do you wake up at night when your parents think you are asleep?’, and ‘Do you feel sleepy during the day?’ The frequency in the past week is rated as rarely (0–1 times), sometimes (2–4 times), and usually (5–7 times). A higher frequency indicates more sleep disturbances

View popup

Table 1. Baseline characteristics of study participants

Baseline characteristic	Valid N	Control group	Valid N	Intervention group
Age (years), median (IQR)	76	9.5 (8.3–11.3)	76	9.1 (8.1–11.2)
Female	76	46 (60.5)	76	51 (67.1)
Rome diagnosis^a	76		76
FAP		29 (38.2)		31 (40.8)
IBS		35 (46.1)		38 (50.0)
AM or FD		10 (13.2)		6 (7.9)
Not fulfilling Rome criteria		2 (2.6)		1 (1.3)
School level	76		76
Primary education		63 (82.9)		62 (81.6)
Secondary education		12 (15.8)		14 (18.4)
Vocational education		1 (1.3)		—
Pain duration (years), median (IQR)	70	2.6 (1.4–4.7)	72	2.1 (0.7–4.5)
History at paediatrician^b	69	19 (27.5)	72	17 (23.6)
School absence	76	38 (50.0)	76	43 (56.6)
Pain severity, median (IQR)	76	6.0 (4.0–7.0)	76	5.0 (4.0–7.0)
Abdominal pain, median (IQR)
Pain intensity score	67	12.0 (7.0–14.0)	73	10.0 (7.0–15.0)
Pain frequency score	67	11.0 (6.0–16.0)	73	9.0 (7.0–17.0)
Health-related quality of life, median (IQR)
Physical wellbeing	76	47.1 (41.1–55.9)	76	47.1 (41.1–54.9)
Psychological wellbeing	76	48.9 (42.0–58.2)	76	48.9 (43.3–57.4)
Moods and emotions	76	41.5 (34.6–48.6)	76	43.9 (36.2–51.3)
Self-perception	76	52.3 (44.7–61.1)	76	49.1 (44.2–61.1)
Autonomy	76	51.0 (47.2–57.1)	76	51.0 (45.7–57.1)
Parent relations and home life	76	52.1 (47.0–58.5)	76	52.1 (46.9–58.5)
Social support and peers	76	53.0 (46.4–60.4)	76	50.7 (46.4–55.4)
School environment	76	52.1 (43.8–57.0)	76	52.1 (43.8–62.5)
Social acceptance (bullying)	76	50.6 (38.3–58.8)	76	44.8 (39.3–58.8)
Financial resources	76	62.9 (49.9–65.0)	76	59.3 (51.9–65.0)
Pain beliefs, median (IQR)
Pain threat	75	2.2 (1.7–2.6)	76	2.2 (1.5–2.7)
Problem-focused coping potential	75	1.5 (0.8–2.0)	76	1.3 (0.7–2.0)
Emotion-focused coping potential	75	2.3 (1.8–3.0)	76	2.3 (1.8–3.0)
Anxiety score, median (IQR)	75	12.0 (8.0–18.0)	76	11.0 (7.0–17.0)
Depression score, median (IQR)	75	3.0 (2.0–4.0)	76	3.0 (1.0–5.0)
Somatisation score, median (IQR)	75	13.0 (7.0–24.0)	76	13.5 (7.5–20.8)
Sleep self-report
Q1: Do you fall asleep in about 20 minutes?	75		76
Usually (5–7)/week		26 (34.7)		24 (31.6)
Sometimes (2–4)/week		24 (32.0)		27 (35.5)
Rarely (0–1)/week or never		25 (33.3)		25 (32.9)
Q2: Do you wake up at night when your parents think you are asleep?	75		76
Rarely (0–1)/week or never		47 (62.7)		48 (63.2)
Sometimes (2–4)/week		16 (21.3)		17 (22.4)
Usually (5–7)/week		12 (16.0)		11 (14.5)
Q3: Do you feel sleepy during the day?	75		76
Rarely (0–1)/week or never		38 (50.7)		38 (50.0)
Sometimes (2–4)/week		28 (37.3)		28 (36.8)
Usually (5–7)/week		9 (12.0)		10 (13.2)
Treatment expectations, median (IQR)^c
Treatment effect NRS-11, child	72	7.0 (6.0–8.0)	74	7.0 (5.0–8.0)
Treatment effect NRS-11, parent 1	76	7.0 (6.0–8.0)	75	7.0 (6.0–8.0)
Treatment effect NRS-11, parent 2	71	7.0 (6.0–8.0)	69	7.0 (5.0–8.0)
Treatment preference, child	73		75
Preference for intervention		52 (71.2)		52 (69.3)
Preference for control		1 (1.4)		2 (2.7)
No preference		20 (27.4)		21 (28.0)
Treatment preference, parents	152		152
Preference for intervention		118 (77.6)		113 (74.3)
Preference for control		1 (0.7)		2 (1.3)
No preference		27 (17.8)		31 (20.4)
Missing		6 (3.9)		6 (3.9)

Values are n (%) unless otherwise indicated. ^aThree children did not fulfil Rome criteria (reported 2–3 days of abdominal pain in past 2 months, required ≥4). ^bPrior paediatric consultations were permitted, but ongoing specialist care at baseline was an exclusion criterion. ^cRange treatment expectations: 0–10. AM = abdominal migraine. FAP = functional abdominal pain. FD = functional dyspepsia. IBS = irritable bowel syndrome. IQR = interquartile range. NRS = numerical rating scale.

View popup

Table 2. Outcomes for abdominal pain in the intention-to-treat population

Outcome	Valid N	Control group	Valid N	Intervention group	Crude OR/Beta^a,b (90% CI)	Adjusted OR/Beta^a,b (90% CI)
Adequate relief, n (%)
3 months	74	42 (56.8)	71	52 (73.2)	2.75 (1.24 to 6.10)^c	2.74 (1.22 to 6.13)^c
6 months	70	41 (58.6)	67	52 (77.6)	3.28 (1.42 to 7.58)^c	4.26 (1.81 to 10.04)^c
12 months	70	52 (74.3)	73	58 (79.5)	1.51 (0.64 to 3.53)	1.73 (0.73 to 4.13)
Pain severity, median (IQR)
3 months	68	5.0 (2.0–6.0)	62	4.0 (1.8–6.0)	−0.36 (−1.07 to 0.35)	−0.31 (−1.00 to 0.38)
6 months	63	5.0 (3.0–6.0)	53	3.0 (1.5–5.0)	−1.40 (−2.14 to −0.65)^c	−1.38 (−2.11 to −0.66)^c
12 months	62	5.0 (2.0–6.0)	67	3.0 (1.0–5.0)	−0.91 (−1.62 to −0.20)^c	−0.89 (−1.57 to −0.20)^c
Pain intensity score, median (IQR)
3 months	41	5.8 (2.0–10.8)	39	5.0 (1.0–9.3)	−0.62 (−2.57 to 1.34)	−1.06 (−2.89 to 0.77)
6 months	41	4.0 (0.0–10.0)	33	4.0 (0.5–10.9)	−0.50 (−2.51 to 1.51)	−1.18 (−3.07 to 0.70)
12 months	46	5.0 (2.0–8.0)	43	2.0 (0.0–7.0)	−1.58 (−3.47 to 0.31)	−2.19 (−3.96 to −0.42)^c
Pain frequency score, median (IQR)
3 months	41	5.6 (1.5–11.8)	39	3.5 (0.1–10.0)	−0.90 (−3.11 to 1.30)	−1.55 (−3.53 to 0.43)
6 months	41	3.3 (0.0–10.2)	33	5.0 (0.5–9.7)	−0.13 (−2.39 to 2.13)	−1.13 (−3.17 to 0.90)
12 months	46	4.8 (1.3–9.3)	43	2.0 (0.0–7.0)	−1.73 (−3.86 to 0.40)	−2.82 (−4.73 to −0.91)^c

^aAdequate relief – odds ratio; pain severity, intensity and frequency – beta. ^bAdjusted for age, baseline pain severity score, child’s expectations, and corresponding baseline score. ^cSignificant at alpha of 0.1. CI = confidence interval. IQR = interquartile range. OR = odds ratio.

Supplementary Data

Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.