Imagining the pain away

Does your kid suffer from frequent tummy aches? A behavioural therapy known as guided imagery may offer a relatively simple way to soothe children's chronic abdominal pain, a study published Monday suggests.

The study, reported in the journal Pediatrics, tested CD-based guided imagery for treating what doctors refer to as functional abdominal pain -- a problem thought to affect up to 20% of children. It is diagnosed when a child's persistent abdominal pain cannot be traced to any disease or physical abnormality.

That lack of a clear underlying cause does not mean, however, that the pain is in children's heads.

"The pain is very real," said Dr. Miranda A. L. van Tilburg, an assistant professor at the University of North Carolina at Chapel Hill and the lead researcher on the new study.

Right now, treatment includes medications - such as drugs to relieve constipation, diarrhoea or acid reflux if they are present, or, in some cases, low-dose antidepressants. Behavioural therapies may also help, but because they are often costly and require a significant time commitment, they may not be feasible for many children.

Guided imagery, on the other hand, is a behavioral technique that can be done at home, van Tilburg said. Sometimes referred to as self-hypnosis, the therapy helps people create relaxing images in their minds to deal with symptoms like stress, anxiety and pain.

"Most parents say they feel unable to cope with their children's pain," van Tilburg told Reuters Health. "So there's really a need for something that they can do at home, right at the time of the pain."

With that goal in mind, van Tilburg and her colleagues developed and recorded onto CD a series of guided-imagery sessions that could be understood by children as young as 6.

For the current study, they randomly assigned 34 children, ages 6 - 15, to either stay with standard care for their functional abdominal pain, or to add home-based guided imagery sessions.

In the latter group, parents and children watched a DVD on guided imagery, and the children were instructed to listen to their CDs at least 5 days per week over 8 weeks.

The sessions guided the children in forming simple, relaxing images. One session, for example, had the children imagine themselves floating on a cloud while a "special object" melted onto one of their hands, making it shiny and warm. They were then told to place that hand on their stomachs and visualize the light and warmth spreading inside their bellies, providing a protective shield.

After 8 weeks, the study found, nearly 3/4 of the children in the guided-imagery group said their pain had decreased by at least half. That compared with 29% of children on standard care alone.

When children in the latter group were then offered guided imagery, about 62% saw their pain decrease by at least half.

It's not clear why guided imagery helps some children, according to van Tilburg. However, one idea is that functional abdominal pain stems, at least in some cases, from hypersensitivity in the rich nerve supply of the gut; guided imagery may help reduce that sensitivity.

The CDs used in this study will not be available to the public any time soon, but van Tilburg and her colleagues are working on making them available to health care providers in the near future.

For now, parents interested in guided imagery can look for a psychologist or other licensed therapist who can help their children learn the technique, according to van Tilburg.

"Using the imagination," she said, "is something children can do naturally and easily."

What do you think of this type of therapy? Or is medicine the way to go?

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