Integrative care for pediatric patients with pain.

OBJECTIVES: Although pediatric patients with chronic pain often turn to complementary therapies, little is known about patients who seek academic integrative pediatric care.

DESIGN: The study design comprised abstraction of intake forms and physician records from new patients whose primary concern was pain.

SETTING/LOCATION: The study setting was an academic pediatric clinic between January 2010 and December 2011.

SUBJECTS: Of the 110 new patients, 49 (45%) had a primary concern about headache (20), abdominal pain (18), or musculoskeletal pain (11).

RESULTS: The average age was 13±4 years, and 37% were male. Patients reported an average pain level of 6±3 on a 10-point scale, and most reported more than one kind of pain; parents had an average of 7±3 health concerns per child, including fatigue (47%), mood or anxiety (45%), constipation/diarrhea (41%), and/or sleep problems (35%). Most patients (57%) were referred by specialists; 71% were taking prescription medications; and 53% were taking one or more dietary supplements at intake. Of those tested, most (61%) had suboptimal vitamin D levels. All families wanted additional counseling about diet (76%), exercise (66%), sleep (58%), and/or stress management (81%). In addition to encouraging continued medical care (100%) and referral to other medical specialists (16%), frequent advice included continuing or initiating dietary supplements such as vitamins/minerals (80%), omega-3 fatty acids (67%), and probiotics (31%). Stress-reducing recommendations included biofeedback (33%), gratitude journals (16%), and yoga/t'ai chi (8%). Other referrals included acupuncture (24%) and massage (20%).

DISCUSSION: Patients who have chronic pain and who present to an integrative clinic frequently have complex conditions and care. They are interested in promoting a healthy lifestyle, reducing stress, and using selected complementary therapies.

CONCLUSION: Patients with chronic pain who seek integrative care may benefit from the kind of coordinated, integrated, comprehensive care provided in a medical home.