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Integrative Services for Pediatric Pain

Q&A with Caitlin Neri, MD, & Laura Goldstein, PsyD

Dr. Neri_Laura_Goldstein

The Pediatric Pain Clinic at Boston Medical Center (BMC) recently received a $50,000 grant from the Marino Foundation for Integrative Medicine to help the clinic expand its integrative services. Co-Directors of the Pediatric Pain Clinic, Caitlin Neri, MD, (left) and Laura Goldstein, PsyD, (right) discuss these services and their unique approach to pain management.

Q. What are some of the services being offered through the Pediatric Pain Clinic at BMC?

A. CN: Our Pediatric Pain Clinic is a true interdisciplinary program. Every patient is seen and evaluated by a physician, a psychologist, and a physical therapist. In addition, families receive caregiver support and guidance from a licensed social worker, as well as ongoing support and education from a nurse with expertise in integrative medicine.

A. LG: We all meet together as a team and develop an individual pain plan that the patient can take home with them. Our goal is for the family to focus on the child's functioning so each pain plan is targeted towards specific techniques and interventions that will be helpful for that particular child. These plans may include medications, interventions to assist with improving sleep, recommendations for diet changes, and/or referrals for integrative therapies like acupuncture or physical therapy. These plans always include behavioral interventions and relaxation strategies for managing pain.

Q. How do integrative medicine therapies help with specific diagnoses?

A. CN: It's not any one intervention that helps with chronic pain. It's all about a multifaceted approach. For each patient, finding the right combination of medications, non-medication strategies, and integrative therapies, along with caregiver support in an interdisciplinary environment, is really the "magic." It's about helping kids and families take control of this pain, which has sometimes controlled their lives for months or even years.

We encourage families to try all the integrative medicine therapies that we offer and decide what works for them.

Q. How do non-pharmacologic therapies work hand-in-hand with medications for your patients?

A. CN: As defined by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, integrative medicine "combines mainstream medical therapies and Complementary and Alternative Medicine (CAM) therapies for which there is some high-quality scientific evidence of safety and effectiveness." This is certainly the approach that we use in the Pain Clinic. We first make sure that threatening causes for pain are ruled out. Then, we can move away from medical evaluation, and instead focus on interdisciplinary pain management using both pharmacological and non-pharmacological approaches.

Q. Which patients are these services most appropriate for? Do some integrative therapies help more with certain conditions?

A. CN: Any patient with distressing recurrent, chronic, or hard-to-manage pain will benefit from an interdisciplinary approach to pain management, which will include non-pharmacologic approaches and integrative therapies.

A. LG: Pain is very individualized. An approach that works for one child may not be effective for another, even if they have similar complaints about their pain. We encourage families to try all the integrative medicine therapies that we offer and decide what works for them.

Q. In your opinion, what's the most interesting form of integrative therapy? Why?

A. CN: I love yoga. Its benefits are incredible for so many conditions, especially musculoskeletal pain, headaches, and neck tension. The breathing and mindfulness that is part of yoga practice, combined with the benefits to musculoskeletal strength and flexibility, are very important to manage chronic pain.

A. LG: I agree, and I also think that aromatherapy can be very helpful. If used in combination with other relaxation strategies that are taught in the clinic, aromatherapy can really help to calm down those heightened signals in the body and messages sent to the brain. The goal is to retrain the brain to reduce the intensity of the pain.

Q. Could you elaborate on details regarding aromatherapy?

lavender oil

{{caption: Lavender oil]]

A. CN: We are not using essential oils in the clinic at this time. However, we do make recommendations of how to use oils at home. An expensive diffuser is not necessary. Instead, families can put a few drops of oil on a warm compress, or use a few drops of essential oils in a carrier oil – also known as base oil, or vegetable oil – to do gentle massage. We provide instructions on how to do this at home. The kids can get involved with picking out scents that they like, but we do make recommendations about which scents can be most helpful for certain conditions. For example, lavender and ylang ylang for sleep and anxiety; and rosemary and eucalyptus for headache; there are many options.

Q. How does acupuncture work for chronic/acute pain? Are there certain trigger points in the body that are specifically targeted?

A. CN: I can tell you what I have learned from Maria Broderick, program director, Program for Integrative Medicine and Healthcare Disparities at BMC and our pain clinic acupuncturist, which is that acupuncture is an ancient Chinese medicine technique that has been used for centuries to treat disease and improve health. The traditional explanation for acupuncture's effectiveness is that it modifies the flow of energy (known as qi or chi) throughout the body. Research has suggested that acupuncture needles at specific points can influence neurotransmitters in the body and offer pain relief. It's also believed that acupuncture restores the balance of energy in the body. In my opinion, if a particular type of therapy makes people feel better, it is worth trying!

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