Integrative Medicine Approach to Pediatric Pain Management

No one gets through childhood without a significant number of minor pains. However, it is estimated that worldwide 20-35% of children experience chronic pain.

Everything that happens during formative times educates the body-mind. During this hyper-adaptable stage, exposure to pain may create functional coping strategies in the moment that ends up being quite counter-productive in the long run as an adult. Research shows that childhood pain exposure may increase the risk for pain and mood disorders in adulthood.

An integrative medicine perspective applies to the snapshot of time as a child experiencing pain and the future impacts of this experience on the nervous system and patterning. There are many instances where the pain is regularly under treated or not considered in infants and children. Also, if not addressed, fear of painful procedures may contribute to medical trauma and lifelong impacts.

A holistic approach will look at ways, particularly non-pharmaceutical ways, to reduce the impact of pain in the present and the future.

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What is Pediatric Pain Management?

Pain management is complex and multifaceted for any person, but pediatric patients present a few unique challenges that further increase the complexity. Pain can be especially difficult for children to deal with both physically and emotionally. Children may not have yet learned coping skills or already know what to expect in ways that help adults to manage pain or fear of pain.

We are learning that the impacts of not treating pain adequately in young patients can have significant negative impacts on their developing nervous systems. So pain, including that from medical procedures, is becoming increasingly recognized, and its management is considered a baseline standard of care. Despite the real risks to the developing nervous system from not adequately addressing pain, it is often under treated or not addressed at all, especially in the very young.

Infants and young children do not have the language skills or even body awareness to specifically and accurately describe their pain. To help with communication, it is useful to bring in validated and age-appropriate pain scales and to make a point of regularly considering pain as part of the patient's care.

Another challenge in managing pain in children is that they are in an inherently vulnerable position, having limited self-agency around managing their pain. They must rely on adults in many stages of seeking pain management or recognizing when pain management changes are needed due to the current protocol not working or excessive side effects.  

Fortunately, many tools are available to reduce pain and help children cope with the experience when some pain is inevitable. The main goals are to maximize the effective reduction in the experience of pain with as few side effects as possible. This is often best accomplished by including a variety of different medications and modalities.

How is Integrative Medicine Used in Pain Management?

Some of the mainstays of pain management, opioid medications, have a lot of undesirable side effects, risk of addiction or overdose, and don't always even work.

Thus, integrative medicine looks at the whole person, not just the symptom of pain. Addressing all aspects of one's health, including the mental, emotional, spiritual, and physical realms, can be used to manage both acute and chronic pain. This often reduces or eliminates the need for other interventions, like strong pain medications. The approach will include a comprehensive evaluation that looks at all aspects of one's health (medical, nutrition, mind-body, etc.), ordering any imaging or labs that may fill in holes of understanding and help to target pain management.

Some commonly used modalities include herbal medicine, acupuncture, yoga, meditation, relaxation techniques, visualization, nutritional support, physical medicine, massage, aromatherapy, hypnosis, yoga, and breathing techniques to stimulate the vagus nerve.

Types of Conditions Addressed in Pediatric Pain Management

Pain management in pediatrics can be for the relatively common childhood experiences of headaches, abdominal pain, and musculoskeletal pain, including acute injuries, growing pains, and pain of unknown cause.

More severe conditions can also begin in childhood, leading to higher-level pain management strategies. Some of these include sickle cell crises, juvenile arthritis, and pain as a result of cancer.

Medical interventions in childhood, from vaccinations to stitches for laceration repair, blood draws, IV placement, or more significant surgeries or treatments, can be a significant source of pain. This pain is often under-addressed in the pediatric population.

Functional Medicine Labs for Pediatric Pain Management

GI Map + Zonulin

This test provides a significant amount of detail about the gut microbiome, possible dysbiosis, and leaky gut that may strongly contribute to chronic functional gastrointestinal pain in children.

P88-DIY Dietary Antigen Test

This test analyzes IgE, IgG, IgG4, and compliment reactions to common foods. It may be useful in cases where food allergies and sensitivities are suspected of contributing to GI pain, headaches, and musculoskeletal pain in children.

Micronutrients + Wheat Zoomer

This test looks at micronutrient status and celiac/non-celiac gluten sensitivity signs. In cases involving celiac or chronic GI pain, the absorption of micronutrients can be impaired. Celiac disease and micronutrient deficiencies can contribute to GI pain, headaches, and musculoskeletal pain in children.

Chronic Pain Panel

The Chronic Pain Panel is a genetic test designed to assess an individual's predisposition to pain perception and sensitivity. This test evaluates various genetic markers associated with inflammation, neurotransmitter function, and pain signaling pathways. By understanding one's genetic predisposition to pain, personalized treatment plans can be developed to manage and alleviate chronic pain in older adults effectively.

Arthritis Panel for Chronic Pain

The Arthritis Panel examines multiple markers linked to inflammation and autoimmune processes in arthritis. This panel is valuable for pediatrics experiencing chronic to rule out arthritis.

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Non Pharmacologic Approaches for Pain in Pediatrics

Non-pharmacological pain management seeks to address pain with methods other than the use of medications. In medical treatments or tests, a commonly used and very simple to implement aspect is reducing stress over the unknown by explaining to a child the details of any procedure happening and potentially letting them play it out on a doll. At the time of procedures, distraction can be very helpful for certain age groups. This would be age-appropriate and can use bright, colorful objects for babies, songs, stories for preschoolers, and TV or music for older children. Training in visualization, relaxation, and hypnosis are other mind-focused options.

The integrative treatment of ongoing pain will usually include personalized suggestions for optimizing nutritional status, exercise, and sleep, as well as suggestions for mind-body modalities unique to the way each individual child is experiencing pain. There are a number of different modalities used in integrative approaches to pain that are being shown in research to be effective and safe. Incorporating these modalities into a holistic pain management program may help to reduce pain levels and improve one's quality of life.

Acupuncture and Acupressure for Pediatric Pain Management

Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. Acupuncture and acupressure are commonly used in the treatment of headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as peri-operative pain. By stimulating specific points on the body, acupuncturists can help relax fascia, and specific muscles that may be causing pain. Acupuncturists also often work with acupoints on specific dermatomes.  Stimulating these points can help relax overly tight muscles, activate weak muscles, and relieve pain. It’s important to find a licensed acupuncturist with extensive training in pediatric pain management.

Chiropractic Care for Pediatric Pain Management

Chiropractors begin a patient assessment with a review of their medical history, an interview to understand the patient's concerns, and a physical exam. The physical exam performed by a DC addresses posture, spinal alignment, and reflexes.

Chiropractors commonly address pain concerns in pediatrics including: musculoskeletal pain, headaches, osteoarthritis, and sports injuries. Treatment plans commonly encompass:  heat or cold therapy, spinal and joint adjustment, soft tissue therapy, taping, physical therapy exercise to be performed at home by the patient, and laboratory testing to rule out inflammation, hormone imbalances, and toxic exposures that may be contributing to ongoing pain.

Yoga & Meditation for Pediatric Pain Management

Yoga is recognized as a form of mind–body medicine that integrates an individual's physical, mental, and spiritual components to improve the aspects of health. Yoga is a low-impact physical activity that has been well researched and now considered by the American Physical Therapy Association as a skilled therapy intervention for pain management.

A specific type of yoga, Iyengar yoga, is based on structural alignment of the physical body through poses with a focus on the use of mind and body components and the use of breathing to support the body and movements as it develops strength, stability, and stamina. Benefits have shown improved body functioning and conditioning, skeletal realignment, which has been useful in the treatment of pediatric pain management.

Massage for Pediatric Pain Management

Massage therapy has shown positive results for gi problems including constipation and diarrhea, for painful procedures and pain syndromes including burns and sickle cell, for muscle tone/movement disorders including cerebral palsy and Down syndrome.

Several potential mechanisms have been suggested for the relationship between massage and pain reduction. One of the early theories for the effectiveness of massage for alleviating pain is that touch receptors (neurons) are longer and more insulated than pain receptors, therefore, can transmit a signal to the brain faster than pain receptors can. The touch message that is received before the pain message then “closes the gate” a biochemical/electrical phenomenon called the “gate theory”, therefore relieving and/or blocking pain signals.

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Summary

Pain management in pediatrics can present some unique challenges, but it is also uniquely important because of the influence of unmanaged pain on the developing nervous system. Functional medicine testing can help get to the root of some of the most common types of childhood pain, such as stomach aches, headaches, and musculoskeletal pain. By then addressing the root causes, the need for ongoing pain management can be reduced.

In addition, integrative medicine has several effective mind-body strategies, such as hypnosis and acupuncture, that work well in children managing pain.