Managing pain in irritable bowel syndrome: current perspectives and best practice.

INTRODUCTION: Irritable bowel syndrome (IBS) is characterized by chronic symptoms (>6 months) of abdominal pain in combination with a disturbed bowel habit. There is an association between the intensity of abdominal pain and the need for health care utilization. A bidirectionally disordered gut-brain interaction is central in the pathophysiology of IBS where a number of factors, gastrointestinal and non-gastrointestinal, can contribute to the illness experience. In order to treat abdominal pain in IBS, mapping these factors in a multidimensional clinical profile is helpful. AREAS COVERED: This review covers basic epidemiology and pathophysiology of abdominal pain in IBS, the diagnostic approach, and a multidimensional treatment model where the management of abdominal pain is in focus. EXPERT OPINION: A personalized treatment of abdominal pain in IBS is possible in patients who understand the diagnosis, the potential of therapies used, and where a good continuity in the patient-doctor relationship is established.

Randomised clinical trial: individual versus group hypnotherapy for irritable bowel syndrome.

BACKGROUND: Gut-directed hypnotherapy improves symptoms for patients with irritable bowel syndrome (IBS). Group hypnotherapy, as well as hypnotherapy administered by nurses, can increase treatment availability, but there are few comparisons between individual and group-based hypnotherapy. AIM: We aimed to evaluate and compare the effectiveness of nurse-administered hypnotherapy for IBS delivered individually or in groups. METHODS: IBS patients were randomised to individual or group hypnotherapy (8 sessions, 12 weeks). The primary endpoint was changes in severity of IBS symptoms. A responder was defined as reduction of IBS severity scoring system (IBS-SSS) ≥50 points at the end of treatment compared to baseline. The effects on extracolonic and psychological symptoms, and quality of life were also assessed. Symptoms were also followed up 6 months after treatment start. RESULTS: A total of 119 patients were randomised (61 individual, 58 group hypnotherapy). Patients reported improvements in IBS symptoms (IBS-SSS) (individual: 332 (273-401) (median, IQR), versus 216 (140-308), (p < 0.0001), group: 315 (239-382), versus 217 (149-314), (p < 0.0001)), with no differences between the groups (p = 0.16). Extracolonic symptoms, psychological symptoms and quality of life also improved, without clear differences between the groups. Sixty-nine percent of the individual hypnotherapy patients were responders after treatment versus 57% of the group hypnotherapy patients (p = 0.25). Symptom improvements were also seen at follow-up. CONCLUSIONS: Nurse-administered gut-directed hypnotherapy, delivered individually or in groups, relieves IBS symptoms, improves psychological symptoms and quality of life. Group hypnotherapy can be an efficacious alternative, enabling more patients to benefit from the treatment (ClinicalTrials.gov ID no of study: NCT03432078).

Nurse-Administered, Gut-Directed Hypnotherapy in IBS: Efficacy and Factors Predicting a Positive Response.

Hypnotherapy is an effective treatment in irritable bowel syndrome (IBS). It is often delivered by a psychotherapist and is costly and time consuming. Nurse-administered hypnotherapy could increase availability and reduce costs. In this study the authors evaluate the effectiveness of nurse-administered, gut-directed hypnotherapy and identify factors predicting treatment outcome. Eighty-five patients were included in the study. Participants received hypnotherapy by a nurse once/week for 12 weeks. Patients reported marked improvement in gastrointestinal (GI) and extra-colonic symptoms after treatment, as well as a reduction in GI-specific anxiety, general anxiety, and depression. Fifty-eight percent were responders after the 12 weeks treatment period, and of these 82% had a favorable clinical response already at week 6. Women were more likely than men to respond favorably to the treatment. Nurse-administered hypnotherapy is an effective treatment for IBS. Being female and reporting a favorable response to treatment by week 6 predicted a positive treatment response at the end of the 12 weeks treatment period.