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A-1406
2003
Acupuncture in the Management of Functional Abdominal Pain in Children
Yuan-Chi Lin, M.D., M.P.H., David Zurakowski, Ph.D.
Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States.
INTRODUCTION

It has been reported that as high as 25% of school-age children will experience recurrent abdominal pain, with the highest prevalence among young girls. In most cases, there is no clear identifiable cause of functional abdominal pain in school-age children.1 Acupuncture has been used clinically as an analgesic although data pertaining to an acupuncture effect on the treatment of abdominal pain is equivocal.2 We report our experience in integrating acupuncture as a complementary therapy for functional abdominal pain in children and adolescents.

METHODS

Our study was approved by the IRB and a written informed consent was obtained prior to acupuncture treatment. Patients under 18 years of age, diagnosed by pediatric gastroenterologists as having functional abdominal pain were included. Acupuncture was performed based on Traditional Chinese Medicine by the same acupuncturist. An associate other than the acupuncturist obtained the pain intensity scores using the Visual Analogue Scale (VAS) for pain from 0 to 10, at the beginning of each session. The acupuncture treatment protocol includes an initial comprehensive evaluation followed by 6 weekly sessions, after which patients may elect to continue bimonthly treatment.

RESULTS

Among the 23 pediatric patients referred for evaluation and management of functional abdominal pain from January to December 2002, 18 completed the 6 weekly acupuncture sessions specified in the study design. There were 13 females and 5 male with mean age 13.7 ± 3.3 years (Mean ± SD). VAS pain scores were 7.1 ± 2.0 at baseline, 5.7 ± 2.0 at 3 weeks, and 3.8 ± 1.7 at 6 weeks. Repeated-measures analysis of variance (ANOVA) indicated a highly significant decrease in weekly VAS pain scores throughout the full 6-week period (Greenhouse-Geisser F-test = 13.98, p < 0.001) that was independent of age (p = 0.96) and gender (p = 0.64). Patients reported less absence from school, increased activity and energy levels, and felt more relaxed. No adverse events were reported from acupuncture treatment.

CONCLUSIONS

Abdominal pain is a frequent complaint among children and adolescents. It can be extremely disabling. Children with functional abdominal pain frequently describe diffuse periumbilical pain that is poorly localized; it rarely radiates to the back or chest. Pain is often worse at night but rarely awakens the child from sleep. In the majority of cases, an underlying etiology is rarely diagnosed. Treatment is aimed at improving function and reducing maladaptive pain behaviors. Medication trials of tricyclic antidepressants and antispasmodics have been used although data on efficacy is limited. Acupuncture has been practiced for more than three millennia. Our experience indicates that acupuncture is well-tolerated and can provide benefit as a complementary method for managing pediatric patients with functional abdominal pain. A prospective, randomized controlled study is needed to evaluate the short- and long-term effects of acupuncture.

REFERENCES

1. Rasquin-Weber A, et al. Childhood functional gastrointestinal disorders. Gut 1999;45: II60-8.

2. Sung J. Acupuncture for gastrointestinal disorders: myth or magic. Gut 2002;51:617-9.

Anesthesiology 2003; 99: A1406