Acupuncture Improves Pain in Pediatric Patients
Interview with Nicole Heuschkel, LAc
New research suggests acupuncture could be just as safe and effective for children as it is for adults. The study found acupuncture provided pain and nausea relief for children suffering from a variety of painful ailments, significantly improving their symptoms and quality of life scores.2
According to Nicole Heuschkel, Lac, a licensed acupuncture therapist at Monmouth Pain and Rehabilitation in Red Bank, New Jersey, the study’s findings are not surprising, as she has had her own success applying the therapy on younger patients.
“A lot of times children respond to treatments quicker than adults,” Ms. Heuschkel said. Acupuncture focuses on using stimulation to free up the body’s natural flow of energy, or “qi,” to achieve a state of homeostasis. Because children may have less-developed blockages than adults, younger patients may respond more effectively to the acupuncture treatments, Ms. Heuschkel explained.
Conducted at an integrative medicine center based in Chicago, Illinois, the study looked at 55 patients (69% female; ages 5-20) presenting with musculoskeletal (75%), abdominal/pelvic (7%), and headache (18%) pain problems. As such, the cohort featured a diverse range of diagnoses, from sports injury, scoliosis, post-concussive injury, and migraine to Crohn’s disease, neurofibromatosis, sickle cell anemia, and leukemia.2
The patients received a course of up to 8 treatment sessions, and after the first treatment, reported significant post-treatment reductions in sensory pain levels. Smaller, progressive reductions in pain occurred in subsequent sessions. A similar pattern of strong initial improvements followed by gradual progressive improvements appeared for nausea scores and quality of life (QoL) scores, with patients reporting “significant reductions in health, emotional, social, and educational problems,” which was corroborated by parental reports, the authors noted.
A Need for More Qualitative Data
The research adds to a growing body of literature supporting the use of acupuncture for children with chronic pain. However, there are still many aspects to this topic left unexplored, according to Lonnie Zeltzer, MD, a professor of pediatrics, anesthesiology, psychiatry, and biobehavioral sciences at the University of California, Los Angeles. “The big questions now are which children with chronic pain would benefit most and what are the characteristics of children that find acupuncture acceptable?”
Dr. Zeltzer and her colleague Michael Waterhouse, a UCLA pediatric pain and palliative care program acupuncturist, were one of the first to publish feasibility studies in acupuncture for pediatric chronic pain in 2000 and 2002.3.4
Given the wide range of ailments the cohort presented, it may have been useful to see which specific diseases garnered the most noticeable improvements, said Dr. Zeltzer. The authors did stratify the patients by “chief complaints,” including headaches (18%), musculoskeletal pain (75%), and abdominal/pelvic pain (7%), but those categories were not evaluated in relation to the pain, nausea, and QoL scores.
Some patients were referred to therapy while others applied directly, which was not described in great detail, Dr. Zeltzer noted. Seeing which patients were eager and responsive to integrating Traditional Chinese Medicine (TCM) could have been beneficial because it also may have indicated what patient types have high potential for achieving significant responses to acupuncture integration.
And while the study did describe a fairly standardized eight-session regimen, using “clean-needle technique” with 36-gauge Seirin needles, it could have been more technically informative to provide data on needle placement and quantity, inclusion of background music, the presence of parents, and other relevant details, said Dr. Zeltzer. While individualized treatments are par for the course in acupuncture practice, culling such qualitative data could help better inform practitioners about how pediatric patients may respond to acupuncture treatments.
Acupuncture for Children: The Recommended Approach
For Ms. Heuschkel, who has been practicing acupuncture for almost 4 years, she finds that earning the child’s trust is the most important step to making treatments successful. Kids can have a natural aversion to needles, even though the technique is virtually painless, so it can require a careful approach to build up their confidence.
“I walk them through the whole procedure beforehand. I show them the needle and the guide tube. Often I tell them to take a deep breath in and then on the exhale, I’ll insert the needle – or I have them cough. That works as a distraction,” noted Ms. Heuschkel.
Before treatment, acupuncturists assess each patient individually, tailoring the most beneficial course of therapy possible. For example, if a young patient presented with a musculoskeletal chronic pain issue, Ms. Heuschkel recommends starting a patient with 2 acupuncture treatments a week for 8 weeks.
“At that point it is good to reevaluate the progress. If there is noticeable progression, a maintenance plan can be put into action, where they would come in once a week for another 4 to 6 weeks.” Treatments could then be tapered down to once every other week or once a month.
Even with a careful approach, young patients still can be too sensitive to the needle, in which case Ms. Heuschkel starts off with non-invasive techniques, like acupressure, sticking seeds onto acupoints, or using magnet therapy.5
Acupuncture, an Ancient Tool for Modern Pain Management
Based in 3,000 years of Traditional Chinese Medicine (TCM), acupuncture may be tentatively accepted by some practitioners. The technique’s philosophic roots in Daoist concepts of yin and yang could lend itself to skepticism over its actual physiological mechanism of action.
Indeed, some studies have found little difference in effectivity between acupuncture and sham acupuncture treatments, which could suggest a placebo effect at play.6,7 Plus, not all health-insurance policies cover acupuncture sessions, which can introduce logistical issues for introducing it into a pediatric patient’s plan of care.
However, while the methodology and mechanics of acupuncture will continue to be analyzed,8,9 its success treating chronic pain is becoming more documented.10 Given its low-risk profile,11,12 it may be a safe integrative medicine for practitioners to consider, especially when trying to avoid the worrisome side-effects of other pharmacological treatments.13,14