Management of chronic pain in children and young people: summary

9. Complementary and alternative therapies

9.1 Acupuncture

One systematic review identified 23 RCTs and presented 8 meta-analyses focusing on acupuncture as an intervention. Nine of these trials enrolled children. All included trials were of low quality and small sample size and none looked at the effect of acupuncture specifically on pain in children [87].

The data presented on harm suggest a possible risk of 5:10,000 for severe or significant adverse events related to acupuncture in children such as sedation, needle pain and neuropathy/nervous system-related issues [87].
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9.2 Qigong and other exercise

A systematic review identified four (4) RCTs of Qigong (a form of gentle physical exercise and breathing control related to tai chi) in patients with fibromyalgia [88]. One trial involved children [89]. This trial assessed the effect of Qigong and aerobic exercise on symptoms including pain, in 30 children with fibromyalgia. There was no placebo group in this trial limiting the interpretation of the findings.
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The results indicated that the C-HAQ (Childhood Health Assessment Questionnaire) Visual Analogue Scale scores measuring the severity of illness and pain improved significantly more in the aerobics group compared to the qigong group at the end of the exercise programme (F[1,21] = 5.32, P = 0.03 versus F[1,21] = 9.75, P = 0.005) [89]. Improvements from baseline in pain scores was seen in both the Qigong and aerobic exercise groups.

9.3 Music Therapy

One systematic review [90] included a single trial in children assessing the effect of music therapy in the treatment of childhood migraine [91]. The results of this trial which was of moderate quality suggested that active participation in music therapy (12 sessions over 28 weeks) reduced the frequency of migraine episodes by 62% compared to a 31% reduction in the placebo group, p < 0.05. Headache intensity was not reduced.
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Recommendations

• Acupuncture may be considered for managing chronic pain in children and young people, for back pain and headache. If used, efficacy should be formally assessed.

• While evidence is very limited, music therapy may be considered for children and young people with chronic migraine.