The Integrative Approach for Management of Pediatric Pain Acupuncture

Chronic pain in the pediatric population is a significant problem. It is estimated that 15–20% of children were affected by chronic pain (Goodman and McGrath 1991). The common pediatric chronic pain symptoms include headache, abdominal pain, and complex-regional pain syndromes (type I and type II). Other pain syndromes can be cerebral palsy (spasticity), malignant tumors, scoliosis, benign tumor, cystic fibrosis, irritable bowl syndrome, fibromyalgia, flat feet, and vertebral and spinal cord abnormalities.Despite advances in understanding and treating chronic pain in pediatric patients, treatment is inadequate in many cases (Anand and Hickey 1987; Romej et al. 1996; Kemper et al. 2000; Howard 2003). The major reasons are several: (1) Pain is multifactorial and that requires patient care considerations beyond the use of analgesics. (2) Pain is a subjective expression that can be easily influenced by the child’s developmental level, past experiences with pain, coping skills, anxiety level, culture, family dynamics, and peer issues, as well as the level of fatigue, focus of attention, and the child’s general state of well-being. (3) Since the treatment of pain relies on self-report, only children who have attained a certain degree of cognitive ability have been able to provide information. Several self-report pain scales/drawings, specifically designed for young children to understand and use, were developed. However, the sensitivity and specificity of these scales remain questionable and frequently rely on how a scale was presented to the child (McGrath et al. 1985). Objective measurements were developed such as behavioral observations, changes in physiologic characteristics, and/ or combinations of these measures. Thus far, facial expression has been one of the most reproducible. However, this behavioral measurement is age related. Generally, the utility of physiologic measures is diminished because of the homeostatic mechanisms that tend to oppose such changes over time. Despite the fact that multiple scales have been developed, each having its advantages and limitations (such as more than 20 validated pain scales to assess the pain in infants), no individual scale has emerged as superior. The lack of a gold standard or a universally reliable indicator that can be used to accurately assess pain in pediatric Shu-Ming Wang