Acupuncture for Children

Children with chronic pain!
 
Dr Thanthullu Vasu
Consultant in Pain Medicine
University Hospitals of Leicester NHS Trust
 
Do children suffer with chronic pain? Yes, chronic persistent pain in children is often unrecognised and undertreated (1). Unfortunately, access to multidisciplinary paediatric pain clinics in our country is limited or non-existent. Leicester is one of the very few hospitals that offer this specialised service for children.
 
Persistent pain in children where there is no identifiable cause leads to significant functional impairment. In majority of the children presenting to the Leicester paediatric pain clinic, pain is not easily linked to a known cause or a well understood pathology.
 
Some of the common conditions presenting to this clinic include:
 
Functional abdominal pain
  • Chronic widespread pain, including spectrum of Functional pain disorders
  • Headaches
  • Hypermobility and joint pains
  • Bone pain, CRPS and post orthopaedic surgical pain
  • Variety of other pain conditions

In the twelve month period between October 2014 and September 2015, this service saw 80 chronic pain children; majority of them were between 12 to 16 years though the age range was between 4-18 years. At least one-fourth of our patients came from outside our neighbouring counties; this explains the need for these services nationwide (2).

Children with persistent pain present with variety of other problems including: sleep problems, problems with school / college attendance, restriction of physical activities, problems with social development and emotional problems. The most important indication for a referral to a tertiary paediatric clinic should be that the child has significant functional or/and emotional impairment, which affects their school/ college attendance; further these children will present with high levels of pain related anxiety.

Chronic pain in children affects the family; there is sufficient evidence to show increased levels of personal strain in family (3). It affects the parents and siblings significantly.

This multidisciplinary clinic aims to restore the social integration of the child; one of the most important tasks in this regard is to improve the school/ college attendance.
Studies have unfortunately shown that chronic pain causes more school absences (4). These children are unable to take part in sports and other extracurricular activities also. Social integration could be really stressful after long absences; education of school staff to pace this could be vital in the recovery (5).
 
The Leicestershire pain service uses a variety of non-medical complimentary treatment strategies and is planning to start an innovative acupuncture service. Acupuncture is widely used in adult chronic pain services all over the country and plays a vital role in the multimodal management strategy. However, access to children for this therapy is limited.
 
Is there evidence for acupuncture in children? A recent properly conducted scientific study (6) done in six large medical centres in America reported significant positive results with this treatment and concluded that is safe and effective in children. A metaanalyses (collection of evidence) from 31 different published articles has found its efficacy and low risk in children (7). Studies have also proven that there is high acceptability and feasibility in children with pain (8). Studies have also shown that children have found acupuncture treatment pleasant and helpful (9).
 
Leicestershire paediatric pain service looks at various innovative ways of developing new services to aid the tool box available for these suffering children to help manage their pain.
 
References:
(1) WHO guidelines on the pharmacological treatment of persistent pain in children with medical illness, World Health Organisation, 2012.
(2) Vasu T. Pain News 2016 (March) (in press).
(3) Hunfeld JAM, Perquin CW et al. Psychology and Psychotherapy 2002; 75(3): 251-260
(4) Logan DE, Simons LE et al. J Pain 2008; 9(5): 407-16
(5) Koontz K, Short AD et al. J Pediatr Psychol 2004; 29:7-17
(6) Johnson A, Paul K et al. Alternative and Complementary Therapies 2015 (Dec); 21(6): 255-60
(7) Jindal V, Ge A et al. J Pediatr Hematol Oncol 2008; 30(6): 431-42
(8) Wu S, Sapru A et al. Pediatr Crit Care Med 2009; 10(3): 291-6
(9) Kemper KJ, Sarah R et al. Pediatrics 2000; 105(3): 941-7.
 

 

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