Comment: The quality of evidence is downgraded by study limitations (lack of blinding of personnel and outcome assessment) and by imprecise results (small studies and few patients).
A Cochrane review included 18 studies with a total of 928 children and adolescents between the ages of 6 and 18 years. No organic cause for this pain can be found on physical examination or investigation for the majority of such children. Treatment success occurred more often with cognitive behavioural therapy (CBT) compared to control after the intervention, but there was no evidence of treatment success at medium-term follow-up (table ). There was no evidence of effects of intervention on pain intensity scores measured postintervention or at medium-term follow-up (table ). There was no difference in quality of life or functional disability between the groups.
For hypnotherapy (including studies of guided imagery) compared to control, there was evidence of greater treatment success postintervention as well as reductions in pain intensity and pain frequency (table ). For yoga therapy compared to control, there was no evidence of effectiveness on pain intensity reduction postintervention (SMD -0.31, 95% CI -0.67 to 0.05; Z = 1.69; P = 0.09; 3 studies; n=122; low-quality evidence).
| Outcome | OR (95% CI) | Probable outcome with control or usual care | Probable outcome with CBT | Number of participants (studies) Quality of evidence |
|---|---|---|---|---|
| Treatment success: postintervention | Pooled OR 5.67 (1.18 to 27.32) | 211 / 1000 | 494 / 1000 | 175 (4) Very low |
| Treatment success: medium-term follow-up (between 3 and 12 months) | Pooled OR 3.08 (0.93 to 10.16) | 349 / 1000 | 551 / 1000 | 139 (3) Low |
| Pain intensity: postintervention Lower score equals less pain. | — | The pain score in the CBT groups was, on average, 0.33 SDs lower (95% CI -0.74 to 0.08) than in the control groups | 405 (7) Low | |
| Pain intensity: medium-term follow-up (between 3 and 12 months) Lower score equals less pain. | — | The pain score in the CBT groups was, on average, 0.32 SDs lower (95% CI -0.85 to 0.20) than in the control groups | 301 (4) Low | |
| Outcomes | OR (95% CI) | Probable outcome with control or usual care | Probable outcome with hypnotherapy | Number of participants (studies) Quality of evidence |
|---|---|---|---|---|
| Treatment success: postintervention | Pooled OR 6.78 (2.41 to 19.07) | 136 / 1000 | 525 / 1000 | 146 (4) Low |
| Pain intensity: postintervention Lower score equals less pain. | — | The pain intensity score in the hypnotherapy groups was, on average, 1.01 SDs lower (95% CI -1.41 to -0.61) than in the control groups. | 146 (4) Low | |
| Pain frequency: postintervention Lower score equals less pain. | — | The pain frequency score in the hypnotherapy groups was, on average, 1.28 SDs lower (95% CI -1.84 to -0.72) than in the control groups. | 146 (4) Low | |
Date of latest search: 9 june 2016