Correlates of Complementary and Alternative Medicine Use in a Pediatric Tertiary Pain Center

Abstract

Objective To examine correlates of Complementary and Alternative Medicine (CAM) use in a pediatric population with chronic pain. To determine if CAM use is positively correlated with adaptive coping skills. Methods We examined patient data from children ages 7–18 (n=1175) with chronic pain who completed the intake assessment at the time of initial evaluation at Boston Children’s multidisciplinary Pain Treatment Service between 2003–2011. The intake assessment included validated measures of anxiety, depression, pain coping skills and functional disability. Parents were also asked whether their child had tried CAM modalities in the past. We used a multivariable logistic regression model to determine correlates of CAM use and a multivariable linear regression model to determine the relationship between bio-behavioral CAM (relaxation training, hypnosis, and biofeedback) and accommodative coping. Results In our multivariable model, we found that female gender (OR 1.47, CI 1.07–2.01), parental education (OR 1.11 per year, CI 1.06–1.16), greater pain intensity (OR 1.06 per point on an 11-point numerical analog scale, CI 1.01–1.11), and more functional disability (OR 1.19 per 10 point increment on the Functional Disability Inventory, CI 1.06–1.34) were independently associated with CAM use. Bio-behavioral CAM was found to have a statistically significant correlation with accommodative coping skills (β 0.2 p-value .003). Conclusion In a pediatric chronic pain center, CAM users tended to have higher pain intensity, and greater functional disability. Exposure to bio-behavioral CAM techniques was associated with adaptive coping skills.

Complementary and Alternative Medicine Use by Children With Pain in the United States

“…Results indicated that a significant portion of children with pain conditions (21.3%) pursue CAM treatments for symptom management. However, this rate is lower than rates of CAM use reported in previous studies among clinical populations of children with pain presenting to multidisciplinary pain clinics (40–60%; 3, 4 ), rheumatology clinics (64%; 14 ), headache clinics (76% 15 ), or gastroenterology clinics (64–95%; 16 ). The discrepancy in rates between our study and others may be related to greater disease severity and disability found in clinical populations or other selection biases in small clinical samples as compared to our nationally-representative population.…”

“…Pain affects 15–25% of children in the United States, and economic expenditures on pediatric pain are estimated at around $11.5 billion annually. 1, 2 Evidence suggest that complementary and alternative medicine (CAM) therapies may be effective for treating pain 3, 4 . However the prevalence, patterns, and perceived benefits of CAM use by children with pain in the United States are unknown.…”

“…5 Hospital pediatric pain management programs often offer one or more CAM approaches for patients, 6 and many pediatric providers discuss or recommend a CAM approach to their patients. 7 Thus far, two studies have explored the use of CAM and attitudes towards CAM in multidisciplinary pediatric pain clinics: Vinson and colleagues found that a significant portion of their patients (42%) had previously tried a CAM modality prior to attending pain clinic, 3 while in a sample of children presenting to pain clinic for initial assessment, the majority of patients (61.2%) elected to include a CAM approach as part of their treatment plan. 4 …”

Pediatric Integrative Medicine

“…12 Children with multiple chronic conditions or greater functional disability from their chronic illness were more likely to use complementary therapies. 5,14,19,20 Data from the National Comorbidity Survey Replication Adolescent Supplement revealed that for youth with any psychiatric disorder, 5.3% received mental health services in a complementary medicine setting within the past 12 months. 21 In a study of 926 children attending 10 Canadian pediatric outpatient specialty clinics (cardiology, gastroenterology, neurology, oncology, and respiratory), Adams et al 4 showed that the prevalence of pediatric complementary therapy use reached up to 70%.…”

“…The use of complementary therapies spans the socioeconomic spectrum and varies considerably among cultural and ethnic groups. 19,20,33 According to the 2012 NHIS, non-Hispanic African American and Hispanic children have the lowest use of complementary therapies in the United States. 12 Researchers in several studies have indicated that complementary medicine use among children may be underreported because certain ethnic populations are less likely to disclose the use of these practices to their providers.…”