Treatment expectations for CAM interventions in pediatric chronic pain patients and their parents

Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, CA 90024, USA.
Evidence-based Complementary and Alternative Medicine (Impact Factor: 1.88). 12/2005; 2(4):521-7. DOI: 10.1093/ecam/neh132
Source: PubMed


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.

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Available from: Margaret C Jacob, Oct 04, 2015
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    • "Patients’ expectations of their interaction with healthcare are based on cognitive and affective beliefs and values, which evolve in an ‘epi-phenomenal’ way through dynamic interplay between the therapy and therapist, and the patient’s subjective experience of change in symptoms [4-6]. Patients’ expectations are culturally modified and vary with age [7-10], gender [11], ethnicity [12], and social factors such as deprivation and unemployment [13]. They also vary with health condition [14]. "
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    ABSTRACT: Background: Patients' expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet. Methods: The study involved development and application of a questionnaire about patients' expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis.The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation "did not happen". Results: 1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP. Conclusions: The findings reflected the complexity of providing osteopathic care and meeting patients' expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research.
    BMC Complementary and Alternative Medicine 05/2013; 13(1):122. DOI:10.1186/1472-6882-13-122 · 2.02 Impact Factor
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    • "Le nombre de publication dans Medline (MESH : hypnosis, dental hypnosis, anesthesia hypnosis) est passé d'environ 200 dans les années quatre-vingts à plus de 600 sur les dix dernières années (2000-2010). L'hypnothérapie a été étudiée dans des essais cliniques pour la douleur et la détresse associée à des procédures interventionnelles (Zeltzer, 1982) [8], (Liossi, 1996) [9] et en pédiatrie (Tsao, 2005) [10]. En oncologie, l'hypnose peut être utilisée comme traitement complémentaire pour soulager la douleur, l'anxiété et les effets secondaires de la chimiothérapie (Deng, 2005) [2], (Dupuis, 2003) [11], (Marchioro, 2000) [12]. "
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    ABSTRACT: Hypnosis is recognised in medicine as an effective complementary therapy. However, few qualitative data are available concerning the benefits it may bring. This qualitative exploratory study aimed to examine the contribution of hypnosis to the care of advanced cancer patients. Results demonstrate that hypnosis is an effective and efficient means of developing the resources of people suffering from serious illness. After an average of four hypnotherapy sessions, patients said they were able to locate previously unexploited resources within themselves and were able to become autonomous in the use of self-hypnosis. The major benefit reported concerned a reduction in anxiety. For patients experiencing anxiety about death, hypnosis allowed them, within a therapeutic environment perceived as safe, to explore different facets of their fears and to develop adaptive strategies. Aside from slight fatigue experienced during the sessions, no adverse side-effects were reported. In conclusion, this study exploring the effects of hypnosis allowed us to identify important benefits for patients suffering from advanced cancer. Consequently, replication on a larger scale is recommended in order to ascertain the extent to which it is possible to generalise from these results and in order better to define the characteristics of patients most likely to benefit from this therapy.
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    • "Parents may experience a general distrust of the medical system and frustration with a lack of conclusive medical tests [7], decreasing their hopes that any health provider will be able to do anything for their child. Due to the failure of treatments to reduce their children's pain, parents may experience reduced expectations for treatment [8]. Since chronic pain is not solely a response to physical sensations, a biopsychosocial approach to treatment is beneficial [9]. "
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    ABSTRACT: Chronic and recurrent pain is experienced by many children and adolescents. Treatment of chronic pain using a multidisciplinary approach has been found to be effective for treatment of chronic pain. Parent satisfaction with treatment and treatment providers highly correlates to children's treatment adherence. Parents of children treated at a multidisciplinary chronic pain clinic were interviewed following their initial appointment. Parents reported high satisfaction with treatment team members and with the treatment plan. Parents also reported appreciation of multidisciplinary structure, the high level of expertise of the team members, and the team members' genuine interest in treating their children. This increase in satisfaction when compared to previous treatment is important since increases in satisfaction may correlate with a reduction in experiences of chronic pain. Parents reported high satisfaction with interactions with treatment team members and with the treatment plan provided for their children. Parents had appreciation of multidisciplinary team structure and the high level of expertise of the team members. This increase in satisfaction when compared to treatment from previous providers is important since increases in satisfaction may correlate with an increase in children's treatment adherence and a reduction in experiences of chronic pain.
    Pain Research and Treatment 08/2012; 2012:791061. DOI:10.1155/2012/791061
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