Treatment Expectations for CAM Interventions in Pediatric Chronic Pain Patients and their Parents

Jennie C I Tsao,Margaret C Jacob,Lonnie K Zeltzer,Marcia Meldrum,Brenda Bursch,Su C Kim

doi:10.1093/ecam/neh132

Abstract

Patient expectations regarding complementary and alternative medicine (CAM) interventions have important implications for treatment adherence, attrition and clinical outcome. Little is known, however, about parent and child treatment expectations regarding CAM approaches for pediatric chronic pain problems. The present study examined ratings of the expected benefits of CAM (i.e. hypnosis, massage, acupuncture, yoga and relaxation) and conventional medicine (i.e. medications, surgery) interventions in 45 children (32 girls; mean age = 13.8 years ± 2.5) and parents (39 mothers) presenting for treatment at a specialty clinic for chronic pediatric pain. Among children, medications and relaxation were expected to be significantly more helpful than the remaining approaches (P < 0.01). However, children expected the three lowest rated interventions, acupuncture, surgery and hypnosis, to be of equal benefit. Results among parents were similar to those found in children but there were fewer significant differences between ratings of the various interventions. Only surgery was expected by parents to be significantly less helpful than the other approaches (P < 0.01). When parent and child perceptions were compared, parents expected hypnosis, acupuncture and yoga, to be more beneficial than did children, whereas children expected surgery to be more helpful than did parents (P < 0.01). Overall, children expected the benefits of CAM to be fairly low with parents' expectations only somewhat more positive. The current findings suggest that educational efforts directed at enhancing treatment expectations regarding CAM, particularly among children with chronic pain, are warranted.

Highlights

The role of patient expectations regarding complementary and alternative medicine (CAM) interventions has received increased attention of late [1,2,3]
Parents who had consulted fewer doctors rated relaxation as being more helpful than parents who had consulted a greater number of doctors (P < 0.01). In this sample of pediatric chronic pain patients presenting to a specialty clinic, we found significant differences in the expected benefits of CAM and conventional medical approaches for a variety of pain problems among parents and children
It is perhaps not surprising that parents considered this most invasive conventional medical approach to be less desirable than children who may not have grasped the full implications of having surgery

Summary

Introduction

The role of patient expectations regarding complementary and alternative medicine (CAM) interventions has received increased attention of late [1,2,3]. A comprehensive review of 85 studies concluded that expectancies appeared to be a mechanism by which placebos exert their effects across a range of clinical conditions and outcomes [11]. It should be noted, that CAM interventions were excluded from this review. Another review which used more stringent criteria for inclusion found that in 15 of 16 studies providing moderatequality evidence, positive expectations were related to better health outcomes [12] It is not stated whether CAM approaches were excluded from this latter review

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Conclusion