ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 123

Acupuncture for Pediatric Chronic Pain Relief: A Review

Yujuan Zhang1, Stephanie Hyon2 and Chenchen Wang3, 1Pediatric Rheumatology, Tufts Medical Center, Boston, MA, 2Rheumatology, Tufts Medical School, Boston, MA, 3Rheumatology, Tufts Medical Center, Boston, MA

Meeting: Pediatric Rheumatology Symposium 2017

Keywords: ,

Session Information

Date: Thursday, May 18, 2017

Title: Clinical and Therapeutic Poster Session

Session Type: Abstract Submissions

Session Time: 5:30PM-7:00PM

Background/Purpose: Acupuncture, a type of complementary and integrative therapy, has been widely used for pain relief in adults. However, evidence of the effect of acupuncture for pediatric chronic pain is scarce. We evaluate the effect of acupuncture on chronic pain in pediatric population.

Methods: We performed a comprehensive search of eastern and western databases in MEDLINE and Chinese databases: China Hospital Knowledge Database, China National Knowledge infrastructure, WanFang Data, and Traditional Chinese Medical Database System until January 2017. Selection criteria included clinical trials and observational studies of acupuncture in pediatric chronic pain patients, sample size ≥8, and outcome measures included pain evaluation.

Results: We identified 142 potentially relevant studies. Eight studies (total 493 participants) met eligibility criteria. Of the 8 studies, 1 was randomized controlled trial, 5 were nonrandomized controlled trials, and 2 were retrospective chart reviews. Four used traditional Chinese acupuncture, 1 Korean hand acupuncture, 1 Japanese style needle, and the other 2 unclear. Table summarizes the studies evaluating the effect of acupuncture on pain. More than 90% of subjects were able to complete all treatments. Acupuncture was associated with a significant pain reduction in 7/8 studies. All 8 studies reported improvement in pain related function after treatments. Four of 8 studies showed a reduction in pain by 3 to 5 points on pain scale; 3/8 studies reported either a high percentage of improvement in pain (70~96%) or a statistically significant reduction on pain scale (1.5 point, P<0.001). One study reported that patients with chronic fatigue improved function (P<0.01). None of the studies reported any adverse effects related to the acupuncture treatment, with 7 studies clearly stating that there were no adverse effects from the acupuncture treatment. Discordant trial designs, varying outcome measures, and methodological limitations precluded a pooled meta-analysis.

Conclusion: The current evidence suggests that acupuncture appears to be safe and helpful treatment for chronic pain in the pediatric population, but is insufficient for a definitive conclusion. Rigorous and well-controlled randomized trials are warranted.

References

1. Pintov S, et al. Pediatr Neurol 1997; 17

2. Jodorkovsky R. Medical Acupuncture 1999

3. Kemper KJ, et al. Pediatrics 2000;105

4. Lin Y-C, et al. Medical Acupuncture 2002;14

5. Zeltzer LK, et al. J Pain Symptom Manage 2002;24

6. Lin Y, et al. Acupuncture in medicine 2004;(16)

7. Lin YC. ASA Annual Meeting. San Francisco (CA), Oct 2007

8. McDonald MJ. Medical Acupuncture 2015; 27

 

          

 Table

Reference

Study Design

age (yr)

N

Indications

Intervention(s) and doses

                 Results

Author’s Conclusions on Acupuncture

[1]

Pintov, 1997

 Israel

Randomized Controlled Trial

 

7-15

22

Migraine headaches

1) TCA1

2) needle in stratum corneum for

placebo acupuncture group

Weekly for 10 weeks

(1) Frequency of Headache reduced 9.3à1.4 in TCA1

(2) VAS2 reduced 8.7à3.3 in TCA1

(3) Panopioid activity inhibition and Beta-endorphinlike immunoreactivity showed changes consistent with effective pain reduction in TCA1

Safe, efficient for migraine headaches in children

[2]

Jodorkovsky, 1999

USA

Nonrandomized controlled studies

3.5-20

106

1. Traumatic pain

2. Musculoskeletal pain (10% chronic)

3. Non-painful conditions

Korean Hand Acupuncture, 1-4+ treatments per subject over 6 months

(1) Pain scale (1 to 10); 96% complete resolution or decrease pain by >50%,

(2) >50% decrease in duration of symptoms in non-painful conditions

Safe, cost-effective and well accepted in children

[3]

Kemper, 2000

USA

Retrospective case series

5-20

47

1. Migraine headaches

2. Endometriosis

3. Reflex sympathetic dystrophy

1) regular needle 98%

2) Moxibustion/heat 85%

3) Cupping 26%, Magnets 26%

Median of 8 treatments over 3 months per subject

(1) 67% of patients (60% of parents) reported the treatments pleasant or relaxing; (2) 70% of patients ( 59% of parents) reported the treatments helpful

Pleasant and helpful in children with chronic pain

[4]

Lin, 2002

USA

Nonrandomized controlled studies

2-18

53

1. limb pain 24%

2. Abd pain 24%

3. back pain 17%

4. Headaches 15%

TCA1; 112 treatments in 53 subjects

VAS2 reduced by a mean of 3.1 points (P<0.01, average effect duration 3 days)

 

Reduced pain in pediatric patients significantly

[5]

Zeltzer, 2002

USA

Nonrandomized controlled studies

6-18

33

1. Migraine headaches 46%

2. Abd pain 21%

3. Fibromyalgia 11%

4. CRPS3 11%

5. JRA4 4%

TCA1 with a 20-minute hypnosis session, weekly for 6 weeks

(1) VAS2 reduced 3.46à1.93 (P<0.001)

(2) Total interference5 reduced 30.48à23.13 (P=0.014)

 

Acupuncture is feasible  with evidence of pain reduction in pediatrics

[6]

Lin, 2004

USA

Nonrandomized controlled studies

11-18

8

Chronic fatigue and pain

Not otherwise specified, at 9 acupuncture points weekly for 6 weeks

(1) VAS2 6.5à5.8 (P>0.5)

(2) Function level (0-10) improved 4.5à7.0 (P<0.01)

Improved functional level in patients with chronic fatigue syndrome

[7]

Lin, 2002

USA

Nonrandomized controlled studies

9-18

50

Headaches

TCA1, weekly for 6 weeks, elective bi-monthly treatment afterwards, mean of 6 treatment per subject

VAS2 reduced 7.4à4.1 (P<0.01)

 

Well tolerated and beneficial treatment for pediatric headaches

[8]

McDonald, 2015

USA

Retrospective chart review

0-21

174

1. Headaches 48%

2. back pain 28%

3. Neck, extremity pain 27%

4. Fibromyalgia 9%

5. Abd pain 9%

6. CRPS3 7%

1) Japanese style needle 96%

2) electroacupuncture 90%

3) Laser therapy 49%

4) Auricular acupuncture 32%

1090 treatment for 174 subjects over 3 years

VAS2 reduced 5.5à2.2 (P<0.001)

Well tolerated, safe and effective for pediatric pain management

1. TCA: traditional Chinese style acupuncture 2. VAS: Visual analogue scale 3. CRPS: Complex Regional Pain Syndrome 4. JRA: Juvenile rheumatoid arthritis 5. Total interference: ratings of total pain-related interference in functioning

Disclosure: Y. Zhang, None; S. Hyon, None; C. Wang, None.

To cite this abstract in AMA style:

Zhang Y, Hyon S, Wang C. Acupuncture for Pediatric Chronic Pain Relief: A Review [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 4). https://acrabstracts.org/abstract/acupuncture-for-pediatric-chronic-pain-relief-a-review/. Accessed .

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