Background & Aims

Chronic pain in children and young people is a significant public health problem and a leading cause of morbidity. Epidemiological studies suggest that chronic pain is experienced by about one-quarter to one-third of children.
Acupuncture can treat not only pain symptoms but also conditions which frequently coexist with chronic pain such as sleep disturbance and anxiety. The British National Institute for Health and Clinical Excellence (NICE) published guidelines asking clinicians to consider a course of acupuncture for people aged 16 years and over to manage chronic primary pain. Whilst most of the evidence-based literature is from adult studies, several studies have demonstrated that acupuncture in children is safe, effective, has a limited number of adverse events, and is well tolerated.
The primary aim of this study was to assess patient reported outcome measures following a course of Western Medical Acupuncture (WMA) therapy in a paediatric outpatient clinic in the UK.

Methods

This was a single-centre study at a tertiary children’s hospital with a well-established Multi-disciplinary Paediatric Chronic Pain Management Service.
A course of 6 acupuncture sessions were offered as part of a multi-modal treatment approach. Patients received information leaflets during MDT clinic appointments, informed consent was signed prior to treatment commencing. Each appointment was 45 minutes with needles in situ for 30 minutes.
63 patients aged 9-18yrs completed the MYMOP2 questionnaire at the beginning and end of their block of treatment. Pain scores (VAS) were recorded at two intervals, along with scores for anxiety and sleep if applicable. Other data collected included area of pain, onset, activity levels & medication. 13 sets of questionnaires were not included as there was missing data. 5 patients had <3 treatment sessions but completed questionnaires, their data is included. Data were collected in SPSS v29 and analysed using repeated measures ANOVA.

Results

Participants: Female 43, Male 7. Mean age 15.02 SD 1.90. Onset of pain: 3 months -1 year= 3 patients; 1-5 years= 29 patients, >5 years =18 patients. Mean number of acupuncture treatments: 5.25 SD 1.13
Impact of acupuncture on pain (difference in pain score from week 1 to end of treatment)- pain worse 8%; pain improved 68%; no difference 24%. Symptom management- 23 patients (46%) reported problems with anxiety at the start of treatment, acupuncture decreased anxiety in 65% of these patients .13 patients (26%) reported problems with sleep which improved for 62% of these patients. 52% of patients reported an increase in activity. 48% reported a reduction in taking medication. Outcomes were better for those who had chronic pain for less than a year compared to those over 5 years. Reduction in pain >5yr group 33%; 3mth-1yr group 100%. Reduction in anxiety >5yr group 33%; 3mth-1yr group 100%. Outcomes were better for those who completed 4 or more treatments, 2 patients had >6 treatments.

Conclusions

The results of this study show that patients experienced a clinically relevant & statistically significant reduction in pain score, a reduction in anxiety & improved sleep following a course of 4 or more acupuncture treatments. Around half of the patients were also able to increase their levels of activity & reduce their need for medication.
Acupuncture is often utilised to avoid or reduce pharmacological therapy or when conventional treatment has proved inadequate or ineffective, therefore it is often a late addition to management plans. The results of this study demonstrate that outcomes are notably better when acupuncture is implemented earlier & when patient’s receive >4 treatment sessions, these finding will be used to guide our future management of chronic pain and service development.
Two patients requested top up treatments, therefore a future longitudinal study is proposed to examine the long term outcomes. A larger sample size study is needed to assess representativeness

References

1.Guidelines on the Management of Chronic Pain in Children. The World Health Organization (2020)
2.Guidelines on the Assessment and Management of Chronic Pain in people aged 16 years and over (2021) The British National Institute for Health and Clinical Excellence (NICE) NG193 Evidence review G (nice.org.uk)
3.Efficacy and Safety of acupuncture in Children: an overview of systematic reviews; Yang,C; Hao,Z; Zang,L & Guo,Q (2015) Pediatric Research Vol 78 No 2
4.Acupuncture for Pediatric Pain; Golianu,B; Yeh,A & Brooks,M (2014) Children 1, 134-148
5.Evidence Based Acupuncture in Anesthesia; Bohling,A & Kitzman,J (2023) Current Anesthesiology Reports 13:125-134
6.Does Acupuncture Hurt? A retrospective study on pain & satisfaction during pediatric acupuncture; Gold,J; Kobylecka,M; Ngo,N; Lin,C & Hurray,C (2023) Children 10:1774
7.Treatment of Frequent or Chronic Primary Headaches in Children & Adolescents: Focus on Acupuncture; Bonemazzi, I et al (2023) Children 10:1626
8.Measuring patient reported outcomes of acupuncture treatment on pain patients’ health status; Vernooij,M & Marcelissen,F (2017) Complementary therapies in clinical practice 1744-3881
9.Core Standards for Pain Management Services in the UK: Second edition (2021) Faculty of Pain Medicine of the Royal College of Anaesthetists

Presenting Author

Stephanie Sinha

Poster Authors

Stephanie Sinha

Mres

Alder Hey Children's NHS Foundation Trust

Lead Author

Jennifer McHugh

Alder Hey Children's NHS Foundation Trust

Lead Author

Topics

  • Pain in Special Populations: Adolescents