1
|
Cuviello A, Cianchini de la Sota A, Baker J, Anghelescu D. Regional blocks for pain control at the end of life in pediatric oncology. FRONTIERS IN PAIN RESEARCH 2023; 4:1127800. [PMID: 37025167 PMCID: PMC10070999 DOI: 10.3389/fpain.2023.1127800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Background Pain management at the end of life is a fundamental aspect of care and can improve patients' quality of life. Interventional approaches may be underutilized for pediatric cancer patients. Objective To describe a single institution's 10 years of experience with regional pain management at the end of life in pediatric oncology. Methods A retrospective cohort study of 27 patients with pediatric cancer who died between April 2011 and December 2021 and received continuous nerve block (CNB) catheters or single-shot nerve blocks (SSBs) during their last three months of life. The type of blocks, analgesic efficacy, and palliative care involvement were evaluated. Results Twenty-two patients (81.5%) had solid tumor diagnoses, including carcinomas, sarcomas, and neuroblastoma. Most (59%) patients received CNB catheters, and 12 patients (44%) received SSBs for pain control. The mean pain score decreases for CNB catheters and SSBs after interventions were -2.5 and -2.8, respectively, on an 11-point scale. Decreases in opioid patient-controlled analgesia dosing requirements were noted in 56% of patients with CNB catheters; likewise, in 25% of patients with SSBs at 24 h and in 8% at 5 days after interventions. Nearly all patients had PC involvement and received care from pain specialists (96% and 93%, respectively). Twenty-three (85%) had physician orders for scope of treatment orders completed before death. Conclusion Regional pain control interventions can be effective and safe for relieving regional pain and suffering in dying children and young adults. The collaboration between palliative care and pain management specialists at the end of life can help alleviate suffering and improve quality of life.
Collapse
Affiliation(s)
- Andrea Cuviello
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Justin Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Doralina Anghelescu
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| |
Collapse
|
2
|
Pooja B, Kamatham R, Anchala K, Avisa P. Effectiveness of low-level laser therapy in reducing pain perception of children during dental local anesthetic administration using laser acupuncture pen on the LI4 point: a randomized clinical trial. Eur Arch Paediatr Dent 2023; 24:219-227. [PMID: 36645646 DOI: 10.1007/s40368-023-00780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/04/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Laser acupuncture, a non-invasive variant of acupuncture, has been proven effective in the medical and dental fields. Hence, the present study aims to determine the effect of low-level laser therapy on the LI4 point, using a laser acupuncture pen, in reducing children's pain during local anesthetic (LA) administration. METHODS Children in the age range of 8-12 years, in need of LA administration, were randomly assigned to two groups: Group I: laser acupuncture, Group II: control. For all the children, baseline simplified Modified Child Dental Anxiety Scale-Faces version (MCDAS(f)) was recorded, followed by laser acupuncture or standard care. Following the conventional protocol, LA was administered. The procedural pain was assessed using the Faces, Legs, Activity, Cry and Consolability scale (FLACC) and Faces Pain Scale-Revised (FPS-R). All the variations in pulse rate were recorded from baseline to the completion of LA administration. After the procedure, simplified MCDAS(f) was recorded one more time. The data were tabulated and analyzed statistically. RESULTS A significant reduction in anxiety after LA administration, as observed in MCDAS(f) score, was noticed only in the laser acupuncture group. The pain scores, as reported in FPS-R, were low in children randomized to the laser group compared to the control. The FLACC pain scores also showed low values in the experimental group. CONCLUSION Based on the study findings, within the limitations, low-level laser therapy using a laser acupuncture pen can reduce the pain perception of children undergoing LA administration and alleviate dental anxiety.
Collapse
Affiliation(s)
- Bellamkonda Pooja
- Pediatric and Preventive Dentistry, Narayana Dental College, Nellore, 524003, Andhra Pradesh, India
| | - Rekhalakshmi Kamatham
- Pediatric and Preventive Dentistry, Narayana Dental College, Nellore, 524003, Andhra Pradesh, India.
| | - Karthik Anchala
- Pediatric and Preventive Dentistry, Narayana Dental College, Nellore, 524003, Andhra Pradesh, India
| | - Priyanka Avisa
- Pediatric and Preventive Dentistry, Narayana Dental College, Nellore, 524003, Andhra Pradesh, India
| |
Collapse
|
3
|
Sommers E, D'Amico S, Goldstein L, Gardiner P. Integrative Approaches to Pediatric Chronic Pain in an Urban Safety-Net Hospital: Cost Savings, Clinical Benefits, and Safety. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:445-453. [PMID: 35285677 DOI: 10.1089/jicm.2021.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: Chronic pain experienced by children and adolescents represents a significant burden in terms of health, quality of life, and economic costs to U.S. families. In 2015, the Boston Medical Center (BMC) Interdisciplinary Pain Clinic initiated an Integrative Medicine (IM) team model to address chronic pain in children. Team members included a pediatrician, child psychologist, physical therapist, acupuncturist, and massage therapist. Children were referred to the pain clinic from primary care and specialty services within BMC, the largest safety-net hospital in the northeastern United States. For this observational assessment, consent and assent were obtained from parents and pediatric patients. Individualized treatment plans were recommended by the IM team. Methods: Self-reported survey and electronic medical record data were collected about socioeconomic demographics, pain, use of medical and IM services, and quality of life. The authors compared health and quality of life indicators and costs of care for each participant from the year before entering the project with these same indicators for the subsequent year. Results: Eighty-three participants were enrolled. Participants ranged in age from 4 to 22 years (mean 14.7 years). Eighty percent of the group were females. Forty-two percent of the sample were white, 30% were Hispanic/Latinx, and 28% were African American. Primary types of pain were abdominal (52%), headache (23%), musculoskeletal (18%), and other (7%). Quality of life indicators improved (p = 0.049) and pain interference decreased (Wilcoxon p = 0.040). Major economic drivers of cost were emergency department (ED) visits, inpatient hospitalizations, and consultations with medical specialists. For the 46 participants who completed the project, the following total cost savings were noted: $27,819 (surgeries), $17,638 (ED visits), $25,033 (hospitalizations), and $42,843 (specialist consults). No adverse events were reported. Conclusion: The authors' experience demonstrated that the use of IM approaches in an interdisciplinary team approach is safe, feasible, and acceptable to families. Considerable cost savings were observed in the area of surgical procedures, hospitalizations, and consultations with specialists.
Collapse
Affiliation(s)
- Elizabeth Sommers
- Department of Family Medicine, Integrative Medicine and Health Disparities Program, Boston Medical Center, Boston, MA, USA
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Salvatore D'Amico
- Department of Family Medicine, Integrative Medicine and Health Disparities Program, Boston Medical Center, Boston, MA, USA
- Cornell Medical Center, Department of Precision Oncology, Herbert Irving Pavilion Cancer Center, New York, NY, USA
| | - Laura Goldstein
- Department of Family Medicine, Integrative Medicine and Health Disparities Program, Boston Medical Center, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Paula Gardiner
- Department of Family Medicine, Integrative Medicine and Health Disparities Program, Boston Medical Center, Boston, MA, USA
| |
Collapse
|
4
|
Mehta V, D'Amico S, Luo M, Bodner K, Goldstein L, Neri C, Gardiner P. Food Habits, Stressors, and Use of Complementary Medicine Therapies Among Pediatric Patients Who Attend an Integrative Medicine Pediatric Pain Clinic. J Altern Complement Med 2020; 26:691-700. [PMID: 32640830 DOI: 10.1089/acm.2019.0253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Chronic pain is a growing problem among children and adolescents, and is more prevalent in low-income families. This observational study was conducted to describe the demographics and various descriptors, complementary medicine therapy (CMT) use, and lifestyle factors (i.e., food habits and supplement use) of pediatric patients with chronic pain. Methods: Boston Medical Center's Interdisciplinary Pediatric Pain Clinic provides patient education and unique treatment plans, tailored with medical and nonpharmacologic interventions for managing complex and chronic pain. Patient data were obtained through electronic medical chart review and self-reported surveys, and were completed by participants and parents at enrollment. Results: Of the 83 participants, the average age was 15.4 ± 4.3, and 80% were female. Referrals to the clinic were due to abdominal pain (52%), headache (23%), and musculoskeletal or other pain (25%). Thirty-one percent were on food assistance programs, with only 24% of patients currently using CMTs and 85% using pain medications. More than half of all participants (63%) missed up to 5 days of school in the past year, while 26% missed more than 6 days. School or academics (77%) were the most frequently self-reported stressor, followed by social/peer issues (39%), bullying (18%), and parental stress (18%). A very small proportion of patients had sufficient intake of dairy (12%), water (23%), vegetables (1%), and fruits (22%). Conclusion: Chronic pain can significantly affect lifestyle factors, stress, and child development. Patients evaluated at the clinic had poor diets and report having stressors regarding school, social/peer issues, parental stress, and bullying.
Collapse
Affiliation(s)
- Vidhita Mehta
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Salvatore D'Amico
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Man Luo
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Kristen Bodner
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Laura Goldstein
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Caitlin Neri
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Paula Gardiner
- Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
5
|
Wang C, Lee YC, Wu MY, Lin CL, Sun MF, Lin JG, Yen HR. Trends in the utilization of acupuncture among children in Taiwan from 2002 to 2011: a nationwide population-based study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:328. [PMID: 31752791 PMCID: PMC6873541 DOI: 10.1186/s12906-019-2753-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND In recent years, acupuncture has been increasingly integrated into pediatric care worldwide. However, recent epidemiological studies about pediatric users of acupuncture are lacking. The current study aimed to fill the gap and carry out the large-scale investigation on the basis of the pediatric population in Taiwan. METHODS We conducted a nationwide population-based study to investigate the utilization of acupuncture in Taiwan. We analyzed data from the Longitudinal Health Insurance Database 2000 (LHID 2000). The datasets contained all original claims data for 1 million beneficiaries who were randomly sampled from the registry of all beneficiaries enrolled in the Taiwan's National Health Insurance Program from January 1, 2000 to December 31, 2011. Children younger than 18 years old were enrolled into our study for analysis. The demographic data, treatment modalities and distributions by disease categories of the pediatric acupuncture users were analyzed by descriptive statistics. Logistic regression analysis was used to investigate the trends in acupuncture use over time. RESULTS The one-year prevalence of pediatric acupuncture users increased from 1.78% in 2002 to 5.34% in 2011. Acupuncture use significantly increased each year (p-value< 0.0001). Patients who were male, of greater age, resided in highly urbanized areas and suffered from injury or disorders of the musculoskeletal system were more likely to accept acupuncture treatment. Infantile cerebral palsy and psychoses were the top two health issues among those receiving complex acupuncture treatment. Older (> 9 years old) children tended to receive acupuncture treatment due to injury and musculoskeletal system disorders more than younger (≤9 years old) children. CONCLUSIONS Our study revealed that the utilization of acupuncture in pediatrics became increasingly popular year by year in Taiwan from 2002 to 2011. The results of this study may provide some valuable information for further clinical practice and acupuncture research, as well as to the government and societies concerning pediatric health care.
Collapse
Affiliation(s)
- Chieh Wang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404 Taiwan
| | - Yu-Chen Lee
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404 Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, 404 Taiwan
| | - Mei-Yao Wu
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404 Taiwan
- School of Post-baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404 Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 404 Taiwan
| | - Mao-Feng Sun
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404 Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, 91 Hsueh-Shih Rd, North District, Taichung, 404 Taiwan
| | - Jaung-Geng Lin
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, 91 Hsueh-Shih Rd, North District, Taichung, 404 Taiwan
| | - Hung-Rong Yen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404 Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, 91 Hsueh-Shih Rd, North District, Taichung, 404 Taiwan
- Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, 404 Taiwan
- Research Center for Chinese Herbal Medicine, China Medical University, Taichung, 404 Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, 404 Taiwan
- Department of Biotechnology, Asia University, Taichung, 413 Taiwan
| |
Collapse
|
6
|
Duffy EA, Dias N, Hendricks-Ferguson V, Hellsten M, Skeens-Borland M, Thornton C, Linder LA. Perspectives on Cancer Pain Assessment and Management in Children. Semin Oncol Nurs 2019; 35:261-273. [PMID: 31078340 DOI: 10.1016/j.soncn.2019.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To report evidence regarding pain assessment and management for children and adolescents receiving treatment for cancer. DATA SOURCES Published research and clinical guidelines. CONCLUSION Children and adolescents experience multiple sources of pain across the cancer continuum. They require developmentally relevant approaches when assessing and managing pain. This review suggests that consideration of the developmental stage and age of the child are essential in both pain assessment and pain management. IMPLICATIONS FOR NURSING PRACTICE Pediatric oncology nurses play a key role in developmentally appropriate pain assessment, identification of potential strategies to manage pain, and delivery of pharmacologic and nonpharmacologic therapies.
Collapse
Affiliation(s)
| | - Nancy Dias
- East Carolina University College of Nursing, Greenville, NC
| | | | - Melody Hellsten
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | - Cliff Thornton
- Herman & Walter Samuelson Children's Hospital of Sinai, Division of Pediatric Hematology/Oncology, Johns Hopkins School of Nursing, Baltimore, MD
| | - Lauri A Linder
- University of Utah, College of Nursing, Salt Lake City, UT; Primary Children's Hospital, Salt Lake City, UT
| |
Collapse
|
7
|
Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. CHILDREN-BASEL 2019; 6:children6020033. [PMID: 30795645 PMCID: PMC6406753 DOI: 10.3390/children6020033] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 12/13/2022]
Abstract
Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.
Collapse
|
8
|
Ramesh G, Gerstbacher D, Arruda J, Golianu B, Mark J, Yeh AM. Pediatric Integrative Medicine in Academia: Stanford Children's Experience. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E168. [PMID: 30545081 PMCID: PMC6306866 DOI: 10.3390/children5120168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable bowel syndrome, acute and chronic pain, headache, and allergy, among others. In light of the growing prevalence of pediatric illnesses and patient complexity, it is crucial to emphasize the patient's overall well-being. As academic centers around the world start to develop pediatric integrative medicine programs, the aim of this manuscript is to briefly highlight evidence of effective integrative treatments in pediatric subspecialties, to describe the establishment of our integrative medicine program, to summarize its early efforts, and to discuss potential barriers and keys to success.
Collapse
Affiliation(s)
- Gautam Ramesh
- School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
| | - Dana Gerstbacher
- Division of Rheumatology, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| | - Jenna Arruda
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| | - Brenda Golianu
- Division of Pediatric Anesthesia and Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| | - John Mark
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| | - Ann Ming Yeh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| |
Collapse
|
9
|
Integrative Pediatrics: Successful Implementation of Integrative Medicine in a German Hospital Setting-Concept and Realization. CHILDREN-BASEL 2018; 5:children5090122. [PMID: 30181478 PMCID: PMC6162590 DOI: 10.3390/children5090122] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023]
Abstract
Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one of them being the “Kinderkrankenhaus St. Marien” in Landshut, Germany. During this project, a concept of the implementation process was developed based on clinical care, teaching, and scientific evaluation. A project group was formed in St. Marien, which included leaders of the hospital, physicians, nurses, and physiotherapists. Over a period of three years, pediatric treatment modalities of the CAM-spectrum were systematically integrated into routine pediatric care and a new integrative medicine department was established. CAM is now being applied in an inpatient as well as outpatient setting, in addition to conventional medical treatments. The modalities now applied include Traditional Chinese Medicine (TCM), relaxation, hypnosis, reflexology, wraps and poultices, aromatherapy, homeopathy, yoga, and herbal medicine. Studies were initiated in some areas. The process and concept leading up to this successful implementation will be described in this article. We show that with motivated team players and structured proceedings, implementation of integrative medicine in a children’s hospital can be successful.
Collapse
|
10
|
Walters CB, Kynes JM, Sobey J, Chimhundu-Sithole T, McQueen KAK. Chronic Pediatric Pain in Low- and Middle-Income Countries. CHILDREN (BASEL, SWITZERLAND) 2018; 5:children5090113. [PMID: 30150600 PMCID: PMC6162626 DOI: 10.3390/children5090113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/03/2018] [Accepted: 08/23/2018] [Indexed: 01/07/2023]
Abstract
Chronic pain is a serious health concern and potentially debilitating condition, leading to anxiety, depression, reduced productivity and functionality, and poor quality of life. This condition can be even more detrimental and incapacitating in the pediatric patient population. In low- and middle-income countries (LMICs), pain services are often inadequate or unavailable, leaving most of the world’s pediatric population with chronic pain untreated. Many of these children in LMICs are suffering without treatment, and often die in pain. Awareness and advocacy for this population must be prioritized. We reviewed the available literature on the chronic pediatric pain burden in LMICs, barriers to treatments, and current efforts to treat these patients.
Collapse
Affiliation(s)
- Camila B Walters
- Department of Anesthesiology, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37209, USA.
| | - J Matthew Kynes
- Department of Anesthesiology, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37209, USA.
| | - Jenna Sobey
- Department of Anesthesiology, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37209, USA.
| | | | - K A Kelly McQueen
- Department of Anesthesiology, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37209, USA.
| |
Collapse
|
11
|
Esparham A, Misra SM, Misra S, Sibinga E, Culbert T, Kemper K, McClafferty H, Vohra S, Rosen L. Pediatric Integrative Medicine: Vision for the Future. CHILDREN-BASEL 2018; 5:children5080111. [PMID: 30127308 PMCID: PMC6111895 DOI: 10.3390/children5080111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 11/17/2022]
Abstract
Pediatric integrative medicine (PIM) is of significant interest to patients, with 12% of the general pediatric population and up to 80% of children with chronic conditions using PIM approaches. The field of PIM has evolved over the past 25 years, approaching child health with a number of guiding principles: preventive, context-centered, relationship-based, personalized, participatory, and ecologically sustainable. This manuscript reviews important time points for the field of PIM and reports on a series of meetings of PIM leaders, aimed at assessing the state of the field and planning for its future. Efforts in the first decade of the 2000s led to increased visibility in academic and professional pediatric organizations and through international listservs, designed to link those interested in and practicing PIM, all of which continue to flourish. The PIM leadership summits in recent years resulted in specific goals to advance PIM further in the following key areas: research, clinical practice, professional education, patient and family education, and advocacy and partnerships. Additionally, goals were developed for greater expansion of PIM professional education, broader support for pediatric PIM research, and an expanded role for PIM approaches in the provision of pediatric care.
Collapse
Affiliation(s)
- Anna Esparham
- Division of Child Neurology-Headache Section, Children's Mercy Hospital, University of Missouri School of Medicine-Kansas City, Kansas City, MO 64108, USA.
| | | | - Sanghamitra Misra
- Mobile Clinic Program, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77054, USA.
| | - Erica Sibinga
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
| | - Timothy Culbert
- Integrative Medicine, Prairie Care, University of Minnesota Medical School, Chaska, MN 55318, USA.
| | - Kathi Kemper
- Department of Pediatrics, College of Medicine, Ohio State University, Columbus, OH 43210, USA.
| | - Hilary McClafferty
- Department of Medicine, Arizona Center for Integrative Medicine, University of Arizona, Tucson, AZ 85724, USA.
| | - Sunita Vohra
- Integrative Health Institute, CARE Program, PedCAM Network, Department of Pediatrics, Medicine, and Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2C8, Canada.
| | | |
Collapse
|
12
|
Dastgheyb S, Fishlock K, Daskalakis C, Kessel J, Rosen P. Evaluating comfort measures for commonly performed painful procedures in pediatric patients. J Pain Res 2018; 11:1383-1390. [PMID: 30100753 PMCID: PMC6067621 DOI: 10.2147/jpr.s156136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Management of pediatric pain from medical procedures is of great importance for improving both patient care and experience. In this study, we investigated methods of managing acute pain in infants and children by studying the correlation between the number of attempts to complete painful procedures, given different comfort measures. Methods The study is a retrospective review of 74,276 procedures performed at two pediatric hospitals in an integrated academic children’s health system between 2013 and 2016. We compared three comfort measures most frequently offered: positions of comfort (POC), distraction (DIST), and pharmacological (PHARM). These methods were compared in the setting of four procedures: peripheral intravenous (PIV) catheter insertion, gastrointestinal tube placement, incision procedures, and bladder catheterization. We used the number of attempts needed to complete a procedure as a measure of efficacy minimizing distressing experience in an acutely painful setting (single attempt vs repeat attempts). Results Among younger children, DIST appears superior to the other two methods; it performs significantly better for three of the four procedures (PIV catheterization, incision wound, and urinary catheterization) among infants aged <1 year and for PIV catheterization among toddlers aged 1–3 years. For older children, POC tends to perform slightly better than the other two methods, although it is significantly better only for PIV catheterization among adolescents aged 13–21 years and urinary catheterization among children aged 9–12 years. Conclusion Results from this study may be used to determine appropriate comfort measures for painful procedures in pediatric setting.
Collapse
Affiliation(s)
| | | | | | - Jami Kessel
- Nationwide Children's Hospital Columbus, OH, USA
| | - Paul Rosen
- Nemours Children's Health System, Wilmington, DE
| |
Collapse
|
13
|
Caes L, Fisher E, Clinch J, Eccleston C. Current Evidence-Based Interdisciplinary Treatment Options for Pediatric Musculoskeletal Pain. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018; 4:223-234. [PMID: 30148046 PMCID: PMC6096755 DOI: 10.1007/s40674-018-0101-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW We review the prevalence of pediatric chronic musculoskeletal pain, the clinical need, the evidence for pharmacological, psychological, physical and, complementary approaches to pain management, and the possible future development of interdisciplinary and distance care. RECENT FINDINGS We summarize the Cochrane Systematic Reviews on pharmacological interventions, which show a lack of evidence to support or refute the use of all classes of medication for the management of pain. The trials for NSAIDs did not show any superiority over comparators, nor did those of anti-depressants, and there are no trials for paracetamol, or of opioid medications. There are studies of psychological interventions which show promise and increasing support for physical therapy. The optimal approach remains an intensive interdisciplinary programmatic treatment, although this service is not available to most. SUMMARY 1. Given the absence of evidence, a program of trials is now urgently required to establish the evidence base for analgesics that are widely prescribed for children and adolescents with chronic musculoskeletal pain. 2. Until that evidence becomes available, medicine review is an essential task in this population. 3. We need more examples and efficacy evaluations of intensive interdisciplinary interventions for chronic pain management, described in detail so that researchers and clinicians can unpack possible active treatment components. 4. Online treatments are likely to be critical in the future. We need to determine which aspects of treatment for which children and adolescents can be effectively delivered in this way, which will help reduce the burden of the large number of patients needing support from a small number of experts.
Collapse
Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK
| | - Jacqui Clinch
- Bristol Royal Children’s Hospital, University of Bristol and Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Experimental, Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
14
|
Shafto K, Gouda S, Catrine K, Brown ML. Integrative Approaches in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E75. [PMID: 29899281 PMCID: PMC6025424 DOI: 10.3390/children5060075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 11/26/2022]
Abstract
Pediatric palliative care is a field which focuses on caring for and treating the symptoms and distress typically associated with life-limiting illness. Integrative medicine is supported by evidence and aims to heal the whole person, including all aspects of one’s lifestyle. Therapies offered by integrative medicine often empower patients and families, allowing for a sense of control. This review addresses the merging of integrative medicine philosophy and modalities with the care given to children with life-limiting illness. We review an introduction to integrative medicine, trends in its incorporation in the healthcare setting, application to patients receiving palliative care and the management of specific symptoms. A case study is offered to illustrate these principles.
Collapse
Affiliation(s)
- Kate Shafto
- Department of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Suzanne Gouda
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA.
| | - Kris Catrine
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Melanie L Brown
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
| |
Collapse
|
15
|
Bodner K, D’Amico S, Luo M, Sommers E, Goldstein L, Neri C, Gardiner P. A cross-sectional review of the prevalence of integrative medicine in pediatric pain clinics across the United States. Complement Ther Med 2018; 38:79-84. [DOI: 10.1016/j.ctim.2018.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022] Open
|
16
|
Thomas R, Phillips M, Hamilton RJ. Pain Management in the Pediatric Palliative Care Population. J Nurs Scholarsh 2018; 50:375-382. [PMID: 29729653 DOI: 10.1111/jnu.12389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this integrative review was to identify, review, synthesize, and analyze the current literature related to pain management in the pediatric palliative care population from infancy through adolescence. METHODS The literature was searched for the terms palliative, pediatric, and pain in PubMed, PsycINFO, Cumulative Index to Nursing and Allied HeALTH LITERATUre (CINAHL) Complete, and Google Scholar. The search was limited to papers in English that had been published from January 1, 2005, to December 31, 2016. RESULTS These searches resulted in 918 articles, of which 29 met inclusion criteria. These 29 articles were reviewed and reported. Four broad themes emerged: patient and family experience, pain assessment, pharmacological pain management, and nonpharmaceutical interventions. CONCLUSIONS Gaps in current research have been identified, such as investigating pediatric pain scales for the palliative care population and new complementary and alternative medical therapy and other interventions. More research is needed to bring innovative pain management interventions to the attention of pediatric caregivers. CLINICAL RELEVANCE A better understanding of current research on pain in the pediatric palliative care population can improve patient care and lead to better research in this specialty field.
Collapse
Affiliation(s)
- Rene Thomas
- Doctoral Student, Rush University College of Nursing, Chicago, IL, USA
| | - Marcia Phillips
- Assistant Professor, Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - Rebekah J Hamilton
- Professor, Department of Women, Children, and Family Nursing, Rush University College of Nursing, Chicago, IL, USA
| |
Collapse
|
17
|
Trifa M, Tumin D, Walia H, Lemanek KL, Tobias JD, Bhalla T. Caregivers' knowledge and acceptance of complementary and alternative medicine in a tertiary care pediatric hospital. J Pain Res 2018. [PMID: 29535550 PMCID: PMC5837374 DOI: 10.2147/jpr.s156585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The use of complementary and alternative medicine (CAM) therapies has increased in children, especially in those with chronic health conditions. However, this increase may not translate into acceptance of CAM in the perioperative setting. We surveyed caregivers of patients undergoing surgery to determine their knowledge and acceptance of hypnotherapy, acupuncture, and music therapy as alternatives to standard medication in the perioperative period. Materials and methods An anonymous, 12-question survey was administered to caregivers of children undergoing procedures under general anesthesia. Caregivers reported their knowledge about hypnotherapy, music therapy, and acupuncture and interest in one of these methods during the perioperative period. CAM acceptance was defined as interest in one or more CAM methods. Results Data from 164 caregivers were analyzed. The majority of caregivers were 20-40 years of age (68%) and mothers of the patient (82%). Caregivers were most familiar with acupuncture (70%), followed by music therapy (60%) and hypnotherapy (38%). Overall CAM acceptance was 51%. The acceptance of specific CAM modalities was highest for music therapy (50%), followed by hypnotherapy (17%) and acupuncture (13%). In multivariable logistic regression, familiarity with music therapy was associated with greater odds of CAM acceptance (odds ratio=3.36; 95% CI: 1.46, 7.74; P=0.004). Conclusion Overall CAM acceptance among caregivers of children undergoing surgery was 51%, with music therapy being the most accepted CAM method. Familiarity with music therapy was the only factor that was independently associated with accepting CAM in the perioperative period. The low acceptance for acupuncture and hypnosis in the perioperative situation may be related to insufficient parental knowledge and information.
Collapse
Affiliation(s)
- Mehdi Trifa
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hina Walia
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathleen L Lemanek
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
18
|
Groenewald CB, Beals-Erickson SE, Ralston-Wilson J, Rabbitts JA, Palermo TM. Complementary and Alternative Medicine Use by Children With Pain in the United States. Acad Pediatr 2017; 17:785-793. [PMID: 28232257 PMCID: PMC5598558 DOI: 10.1016/j.acap.2017.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Chronic pain is reported by 15% to 25% of children. Growing evidence from clinical samples suggests that complementary and alternative medicine (CAM) therapies are desired by families and may benefit some children with pain conditions. The objective of this study was to provide estimates of CAM use by children with pain in the United States. METHODS We analyzed data from the 2012 National Health Interview Survey (NHIS) to estimate patterns, predictors, and perceived benefits of CAM use among children 4 to 17 years of age with and without painful conditions in the United States. We used chi-square tests to compare the prevalence rates of CAM use among children with pain to CAM use among children without pain. Multivariable logistic regression was used to examine factors associated with CAM use within the group of children with pain conditions. RESULTS Parents reported that 26.6% of children had pain conditions (eg, headache, abdominal, musculoskeletal pain) in the past year; of these children, 21.3% used CAM. In contrast, only 8.1% of children without pain conditions used CAM (χ2, P < .001). CAM use among children with pain was associated with female sex (adjusted odds ratio [aOR] = 1.49, P = .005), higher income (aOR = 1.61, P = .027), and presence of 4+ comorbidities (aOR = 2.01, P = .013). Among children with pain who used CAM, the 2 most commonly used CAM modalities were biology-based therapies (47.3%) (eg, special diets and herbal supplements) and manipulative or body-based therapies (46.3%) (eg, chiropractic and massage). CONCLUSIONS CAM is frequently used by children with pain in the United States, and many parents report benefits for their child's symptoms.
Collapse
Affiliation(s)
- Cornelius B Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Wash.
| | - Sarah E Beals-Erickson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Jaime Ralston-Wilson
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Wash
| | - Jennifer A Rabbitts
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Wash
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Wash; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Wash; Department of Psychiatry, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Wash
| |
Collapse
|
19
|
Lazarow F, Andrews RH, Revels J, Shaves S. Migration of innumerable chronically retained acupuncture needles. Radiol Case Rep 2017; 12:546-548. [PMID: 28828123 PMCID: PMC5551984 DOI: 10.1016/j.radcr.2017.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 11/16/2022] Open
Abstract
We present a case of a 50-year-old female with a 2-day history of back and abdominal pain who was discovered to have innumerable chronically retained acupuncture needles, which had migrated throughout her abdomen and pelvis. Although many of these needles were in precarious positions, including the epidural space, renal parenchyma, small bowel, and vasculature, there was no evidence for acute injury. We also briefly discuss evidence for the magnetic resonance imaging compatibility of acupuncture needles. Although a rare complication, given the high frequency of acupuncture therapy in the United States, physicians must be aware of the potential for retained and migrated needles.
Collapse
Affiliation(s)
- Frances Lazarow
- Department of Radiology, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, USA
| | - R Hampton Andrews
- Department of Radiology, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, USA
| | - Jonathan Revels
- Department of Radiology, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, USA
| | - Sarah Shaves
- Department of Radiology, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, USA
| |
Collapse
|
20
|
Rosen DA, Unger K, Gustafson RA, Trieu C, Zeltzer LK, Lin YC. Electroacupuncture Addition to the Anesthesia Care of Pediatric Patients for Congenital Heart Surgery. J Cardiothorac Vasc Anesth 2017; 31:1497-1504. [PMID: 28526209 DOI: 10.1053/j.jvca.2017.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Indexed: 11/11/2022]
Affiliation(s)
- David A Rosen
- Department of Anesthesia and Pediatrics, West Virginia University, Morgantown, WV.
| | - Kendra Unger
- Department of Family Medicine, West Virginia University, Morgantown, WV
| | - Robert A Gustafson
- Department of Surgery and Pediatrics, West Virginia University, Morgantown, WV
| | - Christine Trieu
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Lonnie K Zeltzer
- Departments of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Yuan-Chi Lin
- Medical Acupuncture Service, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
21
|
Kemper KJ, Hill E. Training in Integrative Therapies Increases Self-Efficacy in Providing Nondrug Therapies and Self-Confidence in Offering Compassionate Care. J Evid Based Complementary Altern Med 2017; 22:618-623. [PMID: 29228783 PMCID: PMC5871260 DOI: 10.1177/2156587216686463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background. Patient demand and clinician interest have driven professional training in integrative therapies, but few rigorous evaluations have been published. Methods. This project evaluated the proof of concept of training in acupressure, guided imagery, massage, and Reiki on clinicians’ sense of self-efficacy in providing nondrug therapies, self-confidence in providing compassionate care, and engagement with work. Results. Three out of 4 topics met minimum enrollment numbers; 22 of 24 participants completed follow-up as well as pretraining surveys. All would recommend the training to others and planned changes in personal and professional care. There were significant improvements in self-efficacy in using nondrug therapies, confidence in providing compassionate care, and unplanned absenteeism (P < .05 for each). Conclusion. Training in integrative therapies is feasible and associated with significant improvements in clinicians’ sense of self-efficacy, confidence in providing compassionate care, and engagement with work. Additional studies are needed to determine the impact on quality of care and long-term workforce engagement.
Collapse
Affiliation(s)
| | - Ellie Hill
- 1 The Ohio State University, Columbus, OH, USA
| |
Collapse
|
22
|
Brittner M, Le Pertel N, Gold MA. Acupuncture in Pediatrics. Curr Probl Pediatr Adolesc Health Care 2016; 46:179-83. [PMID: 26867822 DOI: 10.1016/j.cppeds.2015.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022]
Abstract
There has been extensive research on the use of acupuncture in adults with a wide array of conditions. Much less research has been conducted on the use of acupuncture in children. In this article, we review the history and philosophy of acupuncture, and the literature on its effectiveness and safety in children and adolescents, giving special attention to the pediatric and adolescent conditions that have been most studied in high-quality randomized controlled trials (RCTs).
Collapse
Affiliation(s)
- Mindy Brittner
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
| | - Noemie Le Pertel
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
| |
Collapse
|
23
|
Non-pharmacologic Management of Pain and Anxiety in the Pediatric Patient. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0090-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
24
|
McDonald MJ. Acupuncture and Acupuncture-Related Therapies Are Well-Tolerated and Can Effectively Provide Pain Relief in the Pediatric Population. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Mark J. McDonald
- Kosair Children's Hospital and Pediatric Acupuncture, Department of Pediatrics, Division of Pediatric Critical Care, University of Louisville School of Medicine, Louisville, KY
| |
Collapse
|
25
|
Highfield ES, Broderick M, Goldstein L, Dickman L, Neri CM. Acupuncture as Part of a Pediatric Pain Clinic in a Safety-Net Hospital: Acupuncture Wednesday. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ellen Silver Highfield
- Program for Integrative Medicine and Health Disparities, Boston Medical Center, Boston, MA
- Department of Family Medicine, Boston Medical Center, Boston, MA
| | - Maria Broderick
- Program for Integrative Medicine and Health Disparities, Boston Medical Center, Boston, MA
- Department of Family Medicine, Boston Medical Center, Boston, MA
| | - Laura Goldstein
- Department of Child and Adolescent Psychology, Boston Medical Center, Boston, MA
- Pediatric Hematology/Oncology and Pediatric Pain Clinic, Boston University School of Medicine, Boston MA
| | - Laura Dickman
- Department of Child and Adolescent Psychology, Boston Medical Center, Boston, MA
- Pediatric Hematology/Oncology and Pediatric Pain Clinic, Boston University School of Medicine, Boston MA
| | - Caitlin M. Neri
- Pediatric Hematology/Oncology and Pediatric Pain Clinic, Boston University School of Medicine, Boston MA
| |
Collapse
|
26
|
Practitioner Perspectives on Delivering Integrative Medicine in a Large, Acute Care Hospital. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:394040. [PMID: 26693242 PMCID: PMC4674616 DOI: 10.1155/2015/394040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/12/2015] [Indexed: 02/08/2023]
Abstract
Background. We describe the process and challenges of delivering integrative medicine (IM) at a large, acute care hospital, from the perspectives of IM practitioners. To date, minimal literature that addresses the delivery of IM care in an inpatient setting from this perspective exists. Methods. Fifteen IM practitioners were interviewed about their experience delivering IM services at Abbott Northwestern Hospital (ANW), a 630-bed tertiary care hospital. Themes were drawn from codes developed through analysis of the data. Results. Analysis of interview transcripts highlighted challenges of ensuring efficient use of IM practitioner resources across a large hospital, the IM practitioner role in affecting patient experiences, and the ways practitioners navigated differences in IM and conventional medicine cultures in an inpatient setting. Conclusions. IM practitioners favorably viewed their role in patient care, but this work existed within the context of challenges related to balancing supply and demand for services and to integrating an IM program into the established culture of a large hospital. Hospitals planning IM programs should carefully assess the supply and demand dynamics of offering IM in a hospital, advocate for the unique IM practitioner role in patient care, and actively support integration of conventional and complementary approaches.
Collapse
|
27
|
Yang C, Hao Z, Zhang LL, Guo Q. Efficacy and safety of acupuncture in children: an overview of systematic reviews. Pediatr Res 2015; 78:112-9. [PMID: 25950453 DOI: 10.1038/pr.2015.91] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/26/2015] [Indexed: 02/05/2023]
Abstract
In recent years, acupuncture has increasingly being integrated into pediatric health care. It was used on ~150,000 children (0.2%). We aim to update the evidence for the efficacy and safety of acupuncture for children and evaluate the methodological qualities of these studies to improve future research in this area. We included 24 systematic reviews, comprising 142 randomized controlled trials (RCTs) with 12,787 participants. Only 25% (6/24) reviews were considered to be high quality (10.00 ± 0.63). High-quality systematic reviews and Cochrane systematic reviews tend to yield neutral or negative results (P = 0.052, 0.009 respectively). The efficacy of acupuncture for five diseases (Cerebral Palsy (CP), nocturnal enuresis, tic disorders, amblyopia, and pain reduction) is promising. It was unclear for hypoxic ischemic encephalopathy, attention deficit hyperactivity disorder, mumps, autism spectrum disorder (ASD), asthma, nausea/vomiting, and myopia. Acupuncture is not effective for epilepsy. Only six reviews reported adverse events (AEs) and no fatal side effects were reported. The efficacy of acupuncture for some diseases is promising and there have been no fatal side effects reported. Further high-quality studies are justified, with five diseases in particular as research priorities.
Collapse
Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Zilong Hao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Li Zhang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Qin Guo
- Department of Pediatrics, West China Second Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| |
Collapse
|
28
|
Huh J, Butz JL. Pediatric migraine sufferers and alternative therapies. Ment Health Clin 2015. [DOI: 10.9740/mhc.2015.05.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Migraine is a common pediatric disorder, which results in chronic pain. Because of the limited effectiveness of conventional drug regimens, an increased number of pediatric patients look for an alternative medication regimen to prevent and treat migraines.
Method
Search terms “pediatric, headache, migraine, treatment, alternative treatment” were used. Butterbur and riboflavin are suggested as alternative remedies for migraine prophylaxis, and a combination of feverfew and ginger for acute treatment. In addition to previous search terms, “butterbur, riboflavin, feverfew, ginger” were used to review their effectiveness.
Result
Butterbur or riboflavin may be an appropriate alternative regimen to prevent migraine, and a combination of feverfew and ginger may be an option for acute episode.
Conclusion
Study results are promising, but not yet conclusive. Study samples are relatively small. These alternative regimens may benefit pediatric migraine sufferers, but they should be carefully monitored to evaluate individual efficacy when in use.
Collapse
|
29
|
Taylor D, Brady JE, Li G, Sonty N, Saroyan JM. Characterization of pain in patients with Barth syndrome. CHILDRENS HEALTH CARE 2015. [DOI: 10.1080/02739615.2014.996882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
30
|
Defining integrative medicine in narrative and systematic reviews: A suggested checklist for reporting. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2014.11.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
31
|
Integrative Therapy Use for Management of Side Effects and Toxicities Experienced by Pediatric Oncology Patients. CHILDREN-BASEL 2014; 1:424-40. [PMID: 27417488 PMCID: PMC4928739 DOI: 10.3390/children1030424] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/11/2014] [Accepted: 10/29/2014] [Indexed: 01/29/2023]
Abstract
Integrative Therapies (IT), otherwise known as Complementary and Alternative Medicine, are widely used among pediatric oncology patients, despite a paucity of available evidence. This review summarizes surveys that describe the prevalence of IT use by pediatric oncology patients, both during therapy and in survivorship, as well as the modalities being used. Additionally, the evidence that exists for specific treatments that appear to be efficacious in controlling specific symptoms is described. Finally, there are recommendations for practitioners on how to best counsel patients about IT use.
Collapse
|
32
|
Gruber M, Ben-Arye E, Kerem N, Cohen-Kerem R. Use of complementary alternative medicine in pediatric otolaryngology patients: a survey. Int J Pediatr Otorhinolaryngol 2014; 78:248-52. [PMID: 24332665 DOI: 10.1016/j.ijporl.2013.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 11/13/2013] [Accepted: 11/17/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Limited data are available about complementary alternative medicine (CAM) use in children attending otolaryngology services. We investigated the pattern of CAM use among children and adolescents attending a pediatric otolaryngology clinic. METHODS A cross-sectional survey. Anonymous questionnaires were administered, prior to doctor's admission, to parents accompanying young patients attending the pediatric otolaryngology clinic. Parents were asked about their general attitude toward CAM and whether they had ever consulted or considered a consultation with a CAM therapist. Subsequently, CAM users were asked to provide details on CAM modalities used and on their overall satisfaction with CAM therapy. RESULTS Of 308 questionnaires administered, 294 parents responded (95% response rate). Ninety-four parents (32%) reported considering CAM, or previous or current CAM use. Commonly used CAM treatments were acupuncture (44%), homeopathy (36%), and naturopathy (6.7%). CAM users assessed success rate as being: successful (37%), unsuccessful (24%) or undetermined (39%). Successful treatment was described in terms of cure, improvement and better awareness of the problem being addressed. In most cases parents stated that the primary physician was aware of CAM use by the child (74%). CONCLUSIONS CAM plays a substantial role among parents of children referred to pediatric otolaryngology consultation. The otolaryngologist awareness of parents' preference and interest may contribute to decision making regarding pediatric patients' management. Further investigations regarding CAM are warranted and clinical collaboration with CAM therapists should be considered.
Collapse
Affiliation(s)
- Maayan Gruber
- Child Health Center, Armon, Clalit Health Services, Haifa, Israel; Department of Otolaryngology Head and Neck Surgery, Carmel Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Eran Ben-Arye
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Nitai Kerem
- Child Health Center, Armon, Clalit Health Services, Haifa, Israel; Department of Otolaryngology Head and Neck Surgery, Carmel Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Raanan Cohen-Kerem
- Child Health Center, Armon, Clalit Health Services, Haifa, Israel; Department of Otolaryngology Head and Neck Surgery, Carmel Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
33
|
Vinson R, Yeh G, Davis RB, Logan D. Correlates of complementary and alternative medicine use in a pediatric tertiary pain center. Acad Pediatr 2014; 14:491-6. [PMID: 25169161 PMCID: PMC4174311 DOI: 10.1016/j.acap.2014.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/20/2014] [Accepted: 04/22/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine correlates of complementary and alternative medicine (CAM) use in a pediatric population with chronic pain, and to determine whether CAM use is positively correlated with adaptive coping skills. METHODS We examined patient data from 1175 children aged 7 to 18 years with chronic pain who completed the intake assessment at the time of initial evaluation at Boston Children's multidisciplinary Pain Treatment Service between 2003 and 2011. The intake assessment included validated measures of anxiety, depression, pain coping skills, and functional disability. Parents were also asked whether their child had tried CAM modalities in the past. We used a multivariable logistic regression model to determine correlates of CAM use and a multivariable linear regression model to determine the relationship between biobehavioral CAM (relaxation training, hypnosis, and biofeedback) and accommodative coping. RESULTS In our multivariable model, we found that female gender (odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.07-2.02), level of parental education (OR 1.11 per year, 95% CI 1.06-1.16), greater pain intensity (OR 1.06 per point on an 11-point numerical analog scale, 95% CI 1.01-1.11), and more functional disability (OR 1.19 per 10-point increment on the Functional Disability Inventory, 95% CI 1.06-1.34) were independently associated with CAM use. Biobehavioral CAM was found to have a statistically significant correlation with accommodative coping skills (β = 0.2, P = .004). CONCLUSIONS In a pediatric chronic pain center, CAM users tended to have higher pain intensity and greater functional disability. Exposure to biobehavioral CAM techniques was associated with adaptive coping skills.
Collapse
Affiliation(s)
- Rachel Vinson
- Department of General Pediatrics, Boston Children's Hospital, Boston, Mass.
| | - Gloria Yeh
- Beth Israel Deaconess Medical Center, Boston, MA. Internal Medicine
| | - Roger B. Davis
- Beth Israel Deaconess Medical Center, Boston, MA. Internal Medicine
| | - Deirdre Logan
- Boston Children’s Hospital, Boston, MA. Pain Treatment Service
| |
Collapse
|
34
|
Cotton S, Luberto CM, Bogenschutz LH, Pelley TJ, Dusek J. Integrative care therapies and pain in hospitalized children and adolescents: a retrospective database review. J Altern Complement Med 2013; 20:98-102. [PMID: 24175871 DOI: 10.1089/acm.2013.0306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Complementary or integrative care therapies are promising adjunctive approaches to pain management for pediatric inpatients that are currently underused and understudied. The purpose of this study was to examine the potential benefits of integrative care therapies delivered to hospitalized children and adolescents at a large Midwestern academic pediatric medical center over a 1-year period. METHODS A retrospective chart review of an inpatient clinical database maintained by integrative care therapists over a 1-year period was used for the current study. Pre/post pain and relaxation scores associated with the delivery of inpatient integrative care therapies (primarily massage therapy and healing touch) were examined. RESULTS Five-hundred nineteen hospitalized children and adolescents were treated by integrative care therapists for primarily pain or anxiety needs. Patients had a mean age of 10.2 years (standard deviation, 7.0), 224 were female (43%), 383 were white (74%), and most (393 [77%]) received massage therapy. Mean pain and relaxation scores decreased significantly from pre- to post-therapy across all demographic and clinical subgroups (p≤.001). CONCLUSIONS Although integrative care therapies are increasingly requested and offered in children's hospitals, provision of these approaches is driven primarily by consumer demand rather than evidence-informed practice. Future controlled studies should examine the incremental effects of integrative care therapies as an adjunct to conventional treatment, assess how these therapies work mechanistically, and determine whether they improve outcomes, such as pain and cost, for hospitalized children and adolescents.
Collapse
Affiliation(s)
- Sian Cotton
- 1 Department of Family and Community Medicine, Division of Integrative Medicine, Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH
| | | | | | | | | |
Collapse
|
35
|
Shiri S, Feintuch U, Weiss N, Pustilnik A, Geffen T, Kay B, Meiner Z, Berger I. A Virtual Reality System Combined with Biofeedback for Treating Pediatric Chronic Headache—A Pilot Study. PAIN MEDICINE 2013; 14:621-7. [DOI: 10.1111/pme.12083] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Young L, Kemper KJ. Integrative care for pediatric patients with pain. J Altern Complement Med 2013; 19:627-32. [PMID: 23448120 DOI: 10.1089/acm.2012.0368] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Although pediatric patients with chronic pain often turn to complementary therapies, little is known about patients who seek academic integrative pediatric care. DESIGN The study design comprised abstraction of intake forms and physician records from new patients whose primary concern was pain. SETTING/LOCATION The study setting was an academic pediatric clinic between January 2010 and December 2011. SUBJECTS Of the 110 new patients, 49 (45%) had a primary concern about headache (20), abdominal pain (18), or musculoskeletal pain (11). RESULTS The average age was 13±4 years, and 37% were male. Patients reported an average pain level of 6±3 on a 10-point scale, and most reported more than one kind of pain; parents had an average of 7±3 health concerns per child, including fatigue (47%), mood or anxiety (45%), constipation/diarrhea (41%), and/or sleep problems (35%). Most patients (57%) were referred by specialists; 71% were taking prescription medications; and 53% were taking one or more dietary supplements at intake. Of those tested, most (61%) had suboptimal vitamin D levels. All families wanted additional counseling about diet (76%), exercise (66%), sleep (58%), and/or stress management (81%). In addition to encouraging continued medical care (100%) and referral to other medical specialists (16%), frequent advice included continuing or initiating dietary supplements such as vitamins/minerals (80%), omega-3 fatty acids (67%), and probiotics (31%). Stress-reducing recommendations included biofeedback (33%), gratitude journals (16%), and yoga/t'ai chi (8%). Other referrals included acupuncture (24%) and massage (20%). DISCUSSION Patients who have chronic pain and who present to an integrative clinic frequently have complex conditions and care. They are interested in promoting a healthy lifestyle, reducing stress, and using selected complementary therapies. CONCLUSION Patients with chronic pain who seek integrative care may benefit from the kind of coordinated, integrated, comprehensive care provided in a medical home.
Collapse
Affiliation(s)
- Lari Young
- Center for Integrative Medicine, Pediatrics, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | |
Collapse
|
37
|
|
38
|
Highfield ES, Lama P, Grodin MA, Kaptchuk TJ, Crosby SS. Acupuncture and traditional Chinese medicine for survivors of torture and refugee trauma: a descriptive report. J Immigr Minor Health 2012; 14:433-40. [PMID: 22005843 DOI: 10.1007/s10903-011-9538-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Refugees with trauma histories are a difficult medical population to treat. Acupuncture care has gained acceptance in many mainstream hospitals in the United States, but research on acupuncture and refugee populations is limited. Herein, we report our experiences with 50 refugees (total acupuncture treatments = 425) at a major tertiary teaching hospital. Patients often reported extreme trauma including physical torture, rape and witnessing the same in family members. Patients represented 13 different countries, with about half the patients being Somali. The primary complaint of all patients was pain (100%). Using the Wong-Baker Faces Pain scale, 56% patients reported pain decreases. Patient acceptance of acupuncture was high. We provide three case histories as illustrative examples. Further research is warranted.
Collapse
Affiliation(s)
- Ellen Silver Highfield
- Department of Family Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
| | | | | | | | | |
Collapse
|
39
|
|
40
|
Landman ZC, Benjamin Ma C. Acute Multifocal Osteomyelitis Following Acupuncture: A Case Report. JBJS Case Connect 2012; 2:e1. [PMID: 29252452 DOI: 10.2106/jbjs.cc.k.00026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Zachary C Landman
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MU-West, 3rd Floor, San Francisco, CA 94143.
| | | |
Collapse
|
41
|
Gilmour J, Harrison C, Asadi L, Cohen MH, Vohra S. Hospitals and complementary and alternative medicine: managing responsibilities, risk, and potential liability. Pediatrics 2011; 128 Suppl 4:S193-9. [PMID: 22045863 DOI: 10.1542/peds.2010-2720i] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Patients and families increasingly press hospitals to facilitate provision of complementary and alternative medicine (CAM) therapies and products. At the same time, a growing number of hospitals and health care facilities have taken steps to integrate CAM and conventional care. In this article we consider institutional responsibilities when patients/parents use or are considering CAM. We (1) review hospitals' responsibilities to patients and parents, (2) explain how these principles apply in the case of CAM practitioners and products, (3) address institutional responsibilities for different models of service delivery, and (4) highlight issues that should be addressed when developing institutional policies to govern CAM use and propose ways to do so.
Collapse
Affiliation(s)
- Joan Gilmour
- Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
42
|
Tsao JCI, Meldrum M, Kim SC, Jacob MC, Zeltzer LK. Treatment Preferences for CAM in children with chronic pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 4:367-74. [PMID: 17965769 PMCID: PMC1978240 DOI: 10.1093/ecam/nel084] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 09/25/2006] [Indexed: 12/15/2022]
Abstract
CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years ± 2.4; range = 8–18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80%) were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy), pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.
Collapse
Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.
| | | | | | | | | |
Collapse
|
43
|
Relaxation Techniques and Guided Imagery. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
|
44
|
He HG, Lee TL, Jahja R, Sinnappan R, Vehviläinen-Julkunen K, Pölkki T, Ang ENK. The use of nonpharmacological methods for children's postoperative pain relief: Singapore nurses' perspectives. J SPEC PEDIATR NURS 2011; 16:27-38. [PMID: 21294833 DOI: 10.1111/j.1744-6155.2010.00268.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to examine nurses' use of nonpharmacological methods for school-age children's postoperative pain relief. DESIGN AND METHODS A survey was conducted in 2008 with a convenience sample of 134 registered nurses from 7 pediatric wards in Singapore. RESULTS Nurses who were younger, had less education, lower designation, less working experience, and no children of their own used nonpharmacological methods less frequently. PRACTICE IMPLICATIONS Nurses need training and education on nonpharmacological pain relief methods, particularly on methods that have been shown to be effective in prior research but that were less often used by nurses in this study: massage, thermal regulation, imagery, and positive reinforcement.
Collapse
Affiliation(s)
- Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | | | | | | | | | | |
Collapse
|
45
|
Ben-Arye E, Traube Z, Schachter L, Haimi M, Levy M, Schiff E, Lev E. Integrative pediatric care: parents' attitudes toward communication of physicians and CAM practitioners. Pediatrics 2011; 127:e84-95. [PMID: 21187308 DOI: 10.1542/peds.2010-1286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In this study, we explored parents' perspectives toward complementary and alternative medicine (CAM) use by their children and its impact on parent-doctor and doctor-CAM-practitioner communication. PATIENTS AND METHODS We designed a 2-arm study of parents who approached either conventional primary care or CAM clinics with their children to consult physicians or practitioners regarding their child's health. RESULTS A total of 599 parents responded to our questionnaire (319 in 5 conventional clinics [83.9% response rate] and 280 in 21 CAM clinics [71.2% response rate]). Parents in conventional clinics reported less use of CAM by their children within the previous year (35.3% vs 73.7%; P < .0001) but used more traditional and homemade remedies (46.4% vs 12.7%; P < .0001). Both parent groups largely supported informing their child's physician regarding CAM use and expected the physician to initiate a CAM-related conversation and to refer their child to a CAM practitioner. The 2 groups' respondents largely supported communication between the child's physician and the CAM practitioner by the use of a referral/medical letter. Compared with respondents in CAM clinics, parents in conventional clinics were more supportive of CAM integration in a pediatric primary care setting and envisioned a more dominant role of physicians regarding CAM referral and a significant role of physicians in providing CAM. CONCLUSIONS Parents who are referred to conventional and CAM clinics express distinctive attitudes toward CAM integration in pediatric care. Parents perceive physician-CAM practitioner communication as highly important and instrumental in promoting their children's health and safety.
Collapse
Affiliation(s)
- Eran Ben-Arye
- Clalit Health Services, 6 Hashahaf St, Haifa 35013, Israel.
| | | | | | | | | | | | | |
Collapse
|
46
|
Chen L, Houghton M, Seefeld L, Malarick C, Mao J. A Survey of Selected Physician Views on Acupuncture in Pain Management. PAIN MEDICINE 2010; 11:530-4. [DOI: 10.1111/j.1526-4637.2010.00815.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Affiliation(s)
- Robin Slover
- Department of Anesthaseology, University of Colorado Denver, 12401 East 17th Avenue, Aurora, CO 80045, USA.
| | | | | | | |
Collapse
|
48
|
Jastrowski Mano KE, Davies WH. Parental attitudes toward acupuncture in a community sample. J Altern Complement Med 2009; 15:661-8. [PMID: 19489705 DOI: 10.1089/acm.2008.0449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to investigate parental attitudes toward acupuncture for their child. No known research has explored how medical providers discuss acupuncture with families or specific concerns parents have about acupuncture. This study examined whether acupuncture attitudes were influenced by (1) the way acupuncture is explained to parents by a physician and (2) parental experience with acupuncture. DESIGN Parents (N = 240) read vignettes that varied in a 2 (Physician Description of Acupuncture: Traditional Chinese Medicine versus biomedical) x 2 (Gender: male versus female) design and responded to questions assessing their attitudes toward acupuncture. RESULTS A factor analysis of the vignette questions resulted in two factors: acupuncture acceptability (alpha = 0.88) and information seeking (alpha = 0.70). Previous experience with acupuncture significantly increased acupuncture acceptability and reduced interest in information seeking. Parents with experience were more likely to report wanting to pursue acupuncture for their child. A biomedical explanation led to increased acceptability and interest in pursuing information among parents with experience (d = 0.36), and significantly predicted parental agreement with the vignette item, "I would have my child receive acupuncture treatment." Common acupuncture concerns included fear of needles and acupuncture ineffectiveness. CONCLUSIONS Parents' experience with acupuncture, regardless of its perceived helpfulness, appears to play an important role in their consideration of acupuncture for their child. Additional research is needed to fully understand the importance of the way acupuncture is presented to families, as it appears to impact parental attitudes in subtle ways. Parents have numerous concerns regarding acupuncture. Our findings suggest that providers would benefit from increased awareness of families' interest in and use of complementary and alternative medicine so as to better monitor safety, provide advice, and discuss treatment expectations and misconceptions.
Collapse
Affiliation(s)
- Kristen E Jastrowski Mano
- Department of Anesthesiology, Medical College of Wisconsin, Jane B. Pettit Pain and Palliative Care Center, MS 792, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | | |
Collapse
|
49
|
Ossendorf A, Schulte E, Hermann K, Hagmeister H, Schenk M, Kopf A, Schuh-Hofer S, Willich SN, Berghöfer A. Use of complementary medicine in patients with chronic pain. Eur J Integr Med 2009. [DOI: 10.1016/j.eujim.2009.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
50
|
Abstract
Although the past 20 years have yielded an outpouring of research on pain management in children, this information is often not applied uniformly to children in the hospital. To address this deficiency, we developed a systematic institution-wide program to reduce pain in all children in the hospital. Our goal was to create a setting in which attention to pain control and comfort measures would be inherent in all inpatient encounters. We labeled the inpatient unit in which this concept evolved as the "Ouchless Place" and described the program and its development in a 1997 Pediatrics article. In this article we describe the further evolution of that concept in light of the broader changes that have occurred in the field of pain management and in our community. The development of a new children's hospital allowed us to examine what we had learned from our previous experience and modify our program on the basis of that review. This new initiative was renamed "Comfort Central," recognizing that although no inpatient experience could be entirely "ouchless," we could still pledge to families that we were attentive to pain and would provide the most comfort that we could. Specific changes that were put in place in our model included the acquisition of administrative authority to mandate change; the extension of our program to the laboratory, outpatient clinics, and physician offices; the incorporation of newer, more active educational models; increased emphasis on collaboration with other services; increased visibility of pain-relief efforts; and development of an ongoing quality improvement program that monitors the efficacy of pain-relief initiatives in the institution. The elements of this program may be applicable to other health care systems that desire to develop a more cohesive system-wide approach to pain reduction in those for whom they provide care.
Collapse
Affiliation(s)
- Neil L Schechter
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
| |
Collapse
|