“While preliminary evidence is promising, more research will be necessary before providers can confidently assert that hypnosis aides in pain management in pediatric populations,” noted the review authors.1

Acupuncture. Extensive research indicates that acupuncture may represent an effective therapy for the management of pain in adults, and a growing body of evidence suggests that this modality may also be effective to treat acute and chronic pain in pediatric patients. Randomized controlled trials in which the effectiveness of acupuncture was examined in pediatric populations indicate that this approach may be associated with reductions in pain, agitation, and analgesic use in children undergoing minor surgical interventions, and with shorter duration of morphine treatment and hospitalization in infants treated for opioid neonatal abstinence syndrome.1 Studies in youth with chronic pain (eg, headache and endometriosis) have shown similar promise.

“[P]ractitioners should specifically consider incorporating multidisciplinary pain management strategies where possible and feasible for patients for whom prolonged opioid therapy is being considered or prescribed for acute or chronic pain,” concluded the review authors.1 “Many of the integrative non-pharmacological therapies reviewed consist of teaching skills that are applicable beyond an individual pain episode. The patient is taught to implement pain management skills themselves, which may increase the patient’s personal efficacy, coping resources, and overall resilience.”

Clinical Pain Advisor interviewed the following experts to gain clinician perspectives regarding multidisciplinary pediatric pain management: Elisha E. Peterson, MD, FAAP, director of the chronic pain clinic at Children’s National Health System and assistant professor in the department of anesthesiology, pain, and perioperative medicine at George Washington University, Washington, DC, and Wallis T. Muhly, MD, anesthesiologist at the Children’s Hospital of Philadelphia and assistant professor of anesthesiology and critical care in the Perelman School of Medicine at the University of Pennsylvania.

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Clinical Pain Advisor: What does multidisciplinary pain management for pediatric patients typically involve?

Dr Peterson: Multidisciplinary pain management has its origins in the John Bonica model of pain treatment initially started in adults with chronic pain, in which there is an involvement of pain physicians, psychologists, physical therapists, social workers, psychiatrists, and nurses. To be clear on definitions, multidisciplinary care includes many disciplines, but they do not have to be co-located or have coordinated treatment plans. Often, they work in parallel.

Interdisciplinary pain management more accurately reflects academic pediatric chronic pain practices where the multiple disciplines are all on site, hold joint evaluations, and develop integrated treatment plans. Often in children, physical therapy and CBT result in significant improvement in mood, function, and quality of life. In selected cases, interventional pain techniques and medications are used to decrease severe symptoms to facilitate the child’s participation in physical therapy and CBT. Many children and families prefer nonpharmacologic methods to address chronic pain — which is why complementary and integrative modes of therapy such as acupuncture have gained so much traction in pediatric pain management. 

Dr Muhly: Pediatric care has a history of being patient- and family-centered. Pediatric care providers have long realized that they are not only caring for a patient but also the family members who accompany and help coordinate the care of their children. Thus, multidisciplinary pain management includes care for the analgesic and psychological needs of the child and their caregivers as they cope with acute and chronic pain.

An ideal multidisciplinary team includes traditional healthcare providers including surgeons, physicians, and nurse practitioners with experience managing pediatric pain, physical and occupational therapists, and engaged and knowledgeable nurses. In addition, a patient’s recovery from acute and chronic pain experiences can be enhanced with supplemental caregivers, including child life, pediatric pain psychologists, and nontraditional healthcare providers including those with training in acupuncture, aromatherapy, music therapy, and massage therapy, among other techniques.