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Feasibility, satisfaction, and efficacy of acupuncture in pediatric pain
Abstracts
The Journal of Pain
S93
(468) Feasibility, satisfaction, and efficacy of acupuncture in pediatric pain
(470) Heart rate variability biofeedback therapy for children and adolescents with chronic pain
C John, K Kohl, B Horn, M Kobylecka, and J Gold; Children’s Hospital Los Angeles, Los Angeles, CA
A Yetwin, K Marks, T Bell, and J Gold; Children’s Hospital Los Angeles, Los Angeles, CA
In the past 10 years the usage of complementary and alternative medicine (CAM) such as acupuncture has increased as a treatment for pediatric chronic pain. Although acupuncture has been used to treat a diverse range of medical conditions, limited research exists on the feasibility of acupuncture as a viable intervention in the management of pediatric chronic pain. The present study investigates the feasibility, satisfaction, and efficacy of acupuncture in a multidisciplinary pain management clinic located in a large, urban medical center. Thirty-eight children (M=15 years, SD=2.39) from low-income families (81% females, 47% Latina/o) participated in 136 acupuncture sessions with an average of three sessions. Children completed a treatment satisfaction survey with scores ranging from 1 ‘‘strongly disagree’’ to 10 ‘‘strongly agree’’ that acupuncture ‘‘is good’’ (M=9.04, SD=1.35), ‘‘helped me feel better/relaxed’’ (M=8.99, SD=1.41), ‘‘helped me feel less anxious" (M=8.86, SD=1.71) and were satisfied with their acupuncturist (M=9.27, SD=1.08). 90% of the children reported that acupuncture decreased their pain and they reported minimal pain (M=1.41, SD=0.75) out of 10, related to the acupuncture treatment. Ratings of pain were obtained from the FACES Pain Scale-Revised pre- and post-treatment. Analyses controlled for 23% of sessions in which participants reported ‘‘0’’ pain intensity at pre-treatment. Children experienced significant improvements in pain intensity (0–10) from pre-(M=3.96) to post-(M=1.33) treatment (t(103)=14.17, p<.001), with 65% reporting ‘‘0’’ pain intensity at post-treatment. Results support the feasibility, satisfaction, and efficacy of acupuncture as an intervention for patients with chronic pain. Future research will benefit from randomized, controlled studies to further establish the impact of acupuncture usage in managing pain in a pediatric population.
Biofeedback is a noninvasive, cost-effective, and technology-driven therapy that has been found to be a promising clinical intervention for children and adolescents with chronic pain. Recently, investigators have started exploring the efficacy of Heart Rate Variability (HRV) biofeedback for chronic pain because it targets a specific aspect of autonomic regulation. The aim of this pilot study was to explore the application of a brief HRV biofeedback intervention supplemented by at-home breathing practice as a tool for reducing symptomatology associated with chronic pain in a pediatric urban hospital setting. Twenty-one participants between the ages of 10-17 years (M = 14.05, SD = 1.91; 76% female) and their caregivers were recruited from a pain management clinic and the division of rheumatology. Participants were randomized to receive either 1) immediate biofeedback treatment including at-home breathing practice or 2) to be placed on a 4-week waitlist and then enrolled in the biofeedback treatment. Study outcomes included HRV data from biofeedback sessions and self-reported pain intensity, health-related quality of life, sleep, depression, and anxiety sensitivity. Following biofeedback treatment, children in this study achieved significant reductions in self-reported pain intensity, higher levels of self-reported school functioning, and increased HRV, as measured by blood volume pulse amplitude. Pain intensity scores decreased for both treatment groups following treatment, with results indicating a significant time effect for the Faces Pain Scale - Revised (Wilk’s L = .531, F(1, 17) = 15.037, p = .001) and the Varni-Thompson Pediatric Pain Questionnaire (Wilk’s L = .574, F(1, 17) = 12.607, p = .002). The control group reported increased pain intensity over the waitlist period while the treatment group reported pain reductions at the conclusion of biofeedback therapy. Further research is needed to explore the mechanisms underlying HRV biofeedback and its treatment of pediatric chronic pain, including long-term health outcomes.
G02 Holistic/Alternative Medicine
(471) Effects of acupressure on dysmenorrhea in college students: a non-randomized controlled trial
(469) White matter alterations in long-term yoga practitioners: a diffusion-tensor imaging study M Ceko, C Villemure, V Cotton, and M Bushnell; McGill University, Montreal, Quebec, Canada We have previously reported increased cold pain tolerance in long-term yoga practitioners, with grey matter increases in areas related to pain processing and regulation (cingulate cortex, insula, secondary somatosensory cortex). Here we extended our investigation onto the adjacent white matter. We tested 14 long-term yoga practitioners and 14 control subjects matched for sex, age, body mass index, handedness, education and exercise level. After completing the cold pain tolerance task, all subjects participated in an MRI session, which included a diffusion tensor imaging (DTI) scan. DTI images were preprocessed with FSL to obtain whole brain maps of fractional anistropy (FA), which reflects the degree of water diffusion anisotropy (directionality) in white matter. Voxelwise two-sample t tests of FA controlling for age were carried out using TBSS (Tract-Based Spatial Statistics) in FSL. We then examined the correlation between mean FA in significant clusters and pain tolerance scores across both groups. Yoga practitioners showed clusters of increased FA compared to controls in the retrolenticular internal capsule/superior longitudinal fasciculus adjacent to the left insula and in the body of the corpus callosum adjacent to the right cingulate cortex. We confirmed the connectivity of these white matter pathways with the insula and cingulate, respectively, using probabilistic tractography using FSL. The FA increase in yoga practitioners was best described by an increase in water diffusivity along the axon (axial diffusivity) with concomitant decrease of diffusivity perpendicular to the axonal membrane (radial diffusivity), both of which have been associated with enhanced white matter connectivity. Further, FA in these structures was positively correlated with cold pain tolerance across groups. These results suggest that long-term yoga has beneficial effects on the integrity of white matter in pain-related regions, and that these effects are related to higher tolerance of pain.
C Wong, L Kam Yuk, and T Hing Min; The Hong Kong Polytechnic University, Hong Kong, China The aim of this study was to evaluate the effects of Sanyinjiao (SP6) acupressure in reducing the pain level due to primary dysmenorrhea. This is a quasi-experimental study with two-group design. Forty (40) participants with primary dysmenorrhea were allocated either to undergo SP6 acupressure (n=19) or control group (n=21).The experimental group received 20 minutes SP6 acupressure during the intervention session while the control group take rest only. The Pain Visual Analogue scale (PVAS), blood pressure and heart rate were assessed prior to and 1 hour following treatment. Results indicated that there were statistically significant decrease of PVAS immediate after (p=0.003) and one hour (p=0.001) after the 20 minutes of SP6 acupressure. Change of PVAS score immediate (r=-0.46, p=0.045) and one hour post-intervention (r=-0.53, p=0.018) in the experimental group was negatively correlated with the number of hours commenced acupressure after menstruation started. No significant differences were observed in blood pressure and heart rate. These findings suggested that SP6 acupressure have an immediate effect in relieving pain for primary dysmenorrhea. Moreover, early application of acupressure to the SP6 acupoint was shown to be associated with increase reduction of pain severity.
The Journal of Pain
S93
(468) Feasibility, satisfaction, and efficacy of acupuncture in pediatric pain
(470) Heart rate variability biofeedback therapy for children and adolescents with chronic pain
C John, K Kohl, B Horn, M Kobylecka, and J Gold; Children’s Hospital Los Angeles, Los Angeles, CA
A Yetwin, K Marks, T Bell, and J Gold; Children’s Hospital Los Angeles, Los Angeles, CA
In the past 10 years the usage of complementary and alternative medicine (CAM) such as acupuncture has increased as a treatment for pediatric chronic pain. Although acupuncture has been used to treat a diverse range of medical conditions, limited research exists on the feasibility of acupuncture as a viable intervention in the management of pediatric chronic pain. The present study investigates the feasibility, satisfaction, and efficacy of acupuncture in a multidisciplinary pain management clinic located in a large, urban medical center. Thirty-eight children (M=15 years, SD=2.39) from low-income families (81% females, 47% Latina/o) participated in 136 acupuncture sessions with an average of three sessions. Children completed a treatment satisfaction survey with scores ranging from 1 ‘‘strongly disagree’’ to 10 ‘‘strongly agree’’ that acupuncture ‘‘is good’’ (M=9.04, SD=1.35), ‘‘helped me feel better/relaxed’’ (M=8.99, SD=1.41), ‘‘helped me feel less anxious" (M=8.86, SD=1.71) and were satisfied with their acupuncturist (M=9.27, SD=1.08). 90% of the children reported that acupuncture decreased their pain and they reported minimal pain (M=1.41, SD=0.75) out of 10, related to the acupuncture treatment. Ratings of pain were obtained from the FACES Pain Scale-Revised pre- and post-treatment. Analyses controlled for 23% of sessions in which participants reported ‘‘0’’ pain intensity at pre-treatment. Children experienced significant improvements in pain intensity (0–10) from pre-(M=3.96) to post-(M=1.33) treatment (t(103)=14.17, p<.001), with 65% reporting ‘‘0’’ pain intensity at post-treatment. Results support the feasibility, satisfaction, and efficacy of acupuncture as an intervention for patients with chronic pain. Future research will benefit from randomized, controlled studies to further establish the impact of acupuncture usage in managing pain in a pediatric population.
Biofeedback is a noninvasive, cost-effective, and technology-driven therapy that has been found to be a promising clinical intervention for children and adolescents with chronic pain. Recently, investigators have started exploring the efficacy of Heart Rate Variability (HRV) biofeedback for chronic pain because it targets a specific aspect of autonomic regulation. The aim of this pilot study was to explore the application of a brief HRV biofeedback intervention supplemented by at-home breathing practice as a tool for reducing symptomatology associated with chronic pain in a pediatric urban hospital setting. Twenty-one participants between the ages of 10-17 years (M = 14.05, SD = 1.91; 76% female) and their caregivers were recruited from a pain management clinic and the division of rheumatology. Participants were randomized to receive either 1) immediate biofeedback treatment including at-home breathing practice or 2) to be placed on a 4-week waitlist and then enrolled in the biofeedback treatment. Study outcomes included HRV data from biofeedback sessions and self-reported pain intensity, health-related quality of life, sleep, depression, and anxiety sensitivity. Following biofeedback treatment, children in this study achieved significant reductions in self-reported pain intensity, higher levels of self-reported school functioning, and increased HRV, as measured by blood volume pulse amplitude. Pain intensity scores decreased for both treatment groups following treatment, with results indicating a significant time effect for the Faces Pain Scale - Revised (Wilk’s L = .531, F(1, 17) = 15.037, p = .001) and the Varni-Thompson Pediatric Pain Questionnaire (Wilk’s L = .574, F(1, 17) = 12.607, p = .002). The control group reported increased pain intensity over the waitlist period while the treatment group reported pain reductions at the conclusion of biofeedback therapy. Further research is needed to explore the mechanisms underlying HRV biofeedback and its treatment of pediatric chronic pain, including long-term health outcomes.
G02 Holistic/Alternative Medicine
(471) Effects of acupressure on dysmenorrhea in college students: a non-randomized controlled trial
(469) White matter alterations in long-term yoga practitioners: a diffusion-tensor imaging study M Ceko, C Villemure, V Cotton, and M Bushnell; McGill University, Montreal, Quebec, Canada We have previously reported increased cold pain tolerance in long-term yoga practitioners, with grey matter increases in areas related to pain processing and regulation (cingulate cortex, insula, secondary somatosensory cortex). Here we extended our investigation onto the adjacent white matter. We tested 14 long-term yoga practitioners and 14 control subjects matched for sex, age, body mass index, handedness, education and exercise level. After completing the cold pain tolerance task, all subjects participated in an MRI session, which included a diffusion tensor imaging (DTI) scan. DTI images were preprocessed with FSL to obtain whole brain maps of fractional anistropy (FA), which reflects the degree of water diffusion anisotropy (directionality) in white matter. Voxelwise two-sample t tests of FA controlling for age were carried out using TBSS (Tract-Based Spatial Statistics) in FSL. We then examined the correlation between mean FA in significant clusters and pain tolerance scores across both groups. Yoga practitioners showed clusters of increased FA compared to controls in the retrolenticular internal capsule/superior longitudinal fasciculus adjacent to the left insula and in the body of the corpus callosum adjacent to the right cingulate cortex. We confirmed the connectivity of these white matter pathways with the insula and cingulate, respectively, using probabilistic tractography using FSL. The FA increase in yoga practitioners was best described by an increase in water diffusivity along the axon (axial diffusivity) with concomitant decrease of diffusivity perpendicular to the axonal membrane (radial diffusivity), both of which have been associated with enhanced white matter connectivity. Further, FA in these structures was positively correlated with cold pain tolerance across groups. These results suggest that long-term yoga has beneficial effects on the integrity of white matter in pain-related regions, and that these effects are related to higher tolerance of pain.
C Wong, L Kam Yuk, and T Hing Min; The Hong Kong Polytechnic University, Hong Kong, China The aim of this study was to evaluate the effects of Sanyinjiao (SP6) acupressure in reducing the pain level due to primary dysmenorrhea. This is a quasi-experimental study with two-group design. Forty (40) participants with primary dysmenorrhea were allocated either to undergo SP6 acupressure (n=19) or control group (n=21).The experimental group received 20 minutes SP6 acupressure during the intervention session while the control group take rest only. The Pain Visual Analogue scale (PVAS), blood pressure and heart rate were assessed prior to and 1 hour following treatment. Results indicated that there were statistically significant decrease of PVAS immediate after (p=0.003) and one hour (p=0.001) after the 20 minutes of SP6 acupressure. Change of PVAS score immediate (r=-0.46, p=0.045) and one hour post-intervention (r=-0.53, p=0.018) in the experimental group was negatively correlated with the number of hours commenced acupressure after menstruation started. No significant differences were observed in blood pressure and heart rate. These findings suggested that SP6 acupressure have an immediate effect in relieving pain for primary dysmenorrhea. Moreover, early application of acupressure to the SP6 acupoint was shown to be associated with increase reduction of pain severity.