Treatment Preferences for CAM in Children with Chronic Pain

Jennie C. I. Tsao; Marcia Meldrum; Su C. Kim; Margaret C. Jacob; Lonnie K. Zeltzer

Disclosures

Evid Based Complement Alternat Med. 2007;4(3):364-374. 

In This Article

Abstract and Introduction

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.

Recent work suggests that the use of CAM in pediatric populations is increasing substantially.[1] Several studies have reported estimated rates of CAM use in various pediatric populations.[2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18] However, these estimates vary widely from as low as 2% in the general pediatric population[3] to as high as 73% in a sample of children with cancer.[10] Comparisons across studies are complicated by numerous factors including a lack of consensus regarding the definition of CAM, examination of different pediatric populations and variations in survey methodology. Moreover, existing studies have been conducted across several different countries, where attitudes and availability of CAM therapies may differ. In the United States (US), a recent population-based study representative of the general population of children under age 18 years estimated CAM use at only 1.8%.[3] However, this study only included respondents who had consulted a CAM practitioner. Previous research suggests that nearly half of US adults who used CAM did so without consulting a practitioner[19] (for example, taking herbal supplements on one's own), and thus some have suggested that this study likely underestimated use of CAM among children in the US.[20,21]

In the general US adult population, chronic pain is one of the main conditions for which CAM is used.[22,23,24] No existing population-based studies have delineated specific conditions for which CAM is used in children. Nevertheless, it is recognized that children with chronic conditions that may not respond to conventional medicine have especially high rates of CAM use.[25] Several reports indicate increased prevalence of CAM use among pediatric patients with cancer (31-73%),[5,9,10,14,26] juvenile rheumatoid arthritis (70%)[16] and cystic fibrosis (66%).[27] A recent study found that children with chronic illnesses (i.e. cancer, cerebral palsy and inflammatory bowel disease) were three times more likely to use CAM than healthy children.[8] In many of these chronic conditions, pain may be a significant problem.

Despite the high prevalence of CAM use in children with chronic illnesses, little is known regarding patient preferences for specific CAM therapies. A recent randomized trial of adults with low back pain found that patients who expected to receive greater benefit from acupuncture than from massage were more likely to demonstrate better clinical outcomes with acupuncture than with massage, and vice versa.[28] These findings point to the importance of assessing patient expectations and preferences for specific CAM approaches. We recently examined the expected benefits of CAM and conventional therapies in children and their parents presenting for treatment at a multidisciplinary clinic specializing in the treatment of chronic pediatric pain.[29] We found that both parents and children expected relaxation and medication to be more beneficial for pain than hypnosis, massage, acupuncture or yoga. However, in this earlier study we did not assess which specific CAM therapies patients actually preferred when offered their choice of CAM approaches as part of a multimodal treatment package. Thus, the purpose of the current study was to examine patients' preferences for individual CAM therapies for chronic pediatric pain. In addition, we examined the relationship between CAM preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning across a variety of domains. Impairments in functioning constitute a major factor in lower health-related quality of life (HRQOL) among children with chronic pain.[30]

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