Acupuncture And Needlephobia:
The Pediatric Patient's Perspective
Yuan-Chi Lin, MD
Background Although acupuncture can be an effective modality for pediatric pain, "needlephobia" may limit its application.
Objective To assess pediatric patients' fear of needling before and after acupuncture, as well as their perceptions of discomfort and acupuncture effectiveness.
Design, Setting, and Patients Survey of 75 patients (age range, 6-18 years) before and after treatment at a pediatric pain management service in Boston, from January-June 2000.
Main Outcome Measures Initial and subsequent reports of fear of needling, level of discomfort, and perception of treatment effectiveness.
Results Prior to treatment, 40 of the 75 children reported being severely afraid, 22 moderately afraid, 5 mildly afraid, and 8 unafraid of needling. After 6 treatments, the majority (48/75) reported being unafraid of needling, with only 4 still severely afraid. Most children (54/75) reported no treatment-related discomfort. The majority also reported improvement in pain (54/75).
Conclusions To minimize the fear of needling in pediatric patients, pretreatment explanation and demonstration should be provided.
Pediatric Acupuncture, Pediatric Pain, Needlephobia
A growing interest exists among the general public in using alterntive therapies to treat chronic conditions.1 The National Institutes of Health Consensus Development Panel on Acupuncture provides a broad overview of the effects of acupuncture and research references.2
Pediatric chronic pain treatment requires a multidisciplinary approach. Our pediatric pain management service commonly provides various therapies including pain medications, physical therapy, occupational therapy, counseling for behavioral medicine, guided imagery, biofeedback, relaxation therapy, massage therapy, music therapy, art therapy, and acupuncture. A recent report revealed that more than 30% of pediatric pain centers offer acupuncture for pain management.3 Pediatric patients' perception of needling is often a barrier when first introducing acupuncture to the patient. We conducted a study to assess this perception ("needlephobia") before and after acupuncture treatment.
Pediatric patients at a pain management service in Boston were offered acupuncture as complementary therapy for chronic pain conditions. All patients' legal guardians gave informed consent before treatment. An explanation and demonstration of acupuncture were given at the initial visit. All patients were offered acupuncture treatment once weekly for 6 sessions, based on a Traditional Chinese Medicine approach (Seirin No. 3, 0.20 gauge x 30 mm acupuncture needles were used). Patients were either sitting in their parents' lap or lying on a massage table in the clinic. Acupuncture point selections are described.4
This study was conducted from January-June 2000 and approved by the IRB. An independent observer obtained information about the patients' perception of the acupuncture treatment. Before the 1st treatment, patients were asked, "Are you severely afraid of, moderately afraid of, mildly afraid of, or not at all afraid of the upcoming acupuncture treatment?" At the conclusion of the 6 sessions, the independent observer asked the patient, "How afraid are you of the acupuncture treatment now: severely afraid of, moderately afraid of, mildly afraid of, or not at all afraid of it?" The patients were then asked, "What was your level of discomfort during the acupuncture treatment: no discomfort at all, mild discomfort, moderate discomfort, or extreme discomfort?"
The observer obtained additional information at the conclusion of the 6 treatments: "Do you think the acupuncture treatments helped you for your pain, or not? Have you experienced any improvement in your function? Would you recommend acupuncture to your friends?"
Ninety-one children with chronic pain disorders were offered acupuncture therapy. Of these children, 4 refused acupuncture and 87 received treatment. Twelve children were unable to complete the study and were excluded: 6 patients lived far from our medical center and were referred to local acupuncturists; 5 patients were developmentally delayed and lacked verbal skills to effectively communicate with the examiner; and 1 child died of the cancer that brought him into the study. Seventy-five children completed the survey and evaluated their experiences.
Figure 1. Pediatric Patients' Responses About Fear of Acupuncture Before and After Treatment (n=75)
The 75 pediatric patients (21 boys and 54 girls) were a mean (SD) age of 14 (3.0) years (range, 6-18 years). Chief complaints at the initial consultation included headache (18 [24%]), neck pain (12 [16%]), chest pain (5 [7%]), abdominal pain (19 [25%]), back pain (13 [17%]), and pain in a limb (8 [11%]). The patients' responses to the questions about fear of acupuncture are presented in Figure 1. In response to the questions about the discomfort level during the treatment, 54 (72%) stated that they felt no procedure-related discomfort, 18 (24%) felt mild discomfort, 2 (3%) felt moderate discomfort, and 1 (1%) felt severe discomfort. Fifty-four of the children (72%) reported that acupuncture was helpful, 30 (40%) reported improvement in function, and 70 (93%) said they would recommend acupuncture to their friends.
Needlephobia, a common problem for practitioners of acupuncture treatment in children, can be minimized by careful preprocedural explanation and demonstration. As our study documented, initial feelings of fear of acupuncture needles were greatly reduced after the children actually experienced the treatments. Procedure-related discomfort was nonexistent to mild for most children. Overall, patients reported that acupuncture was helpful to them and improved their conditions. The great majority of the children had positive experiences and would recommend acupuncture to their friends.
This study was limited by the exclusion of the patients who lacked verbal skills to communicate with the examiner. For the purposes of documentation, it was determined that this exclusion was necessary. However, acupuncture can be effectively used in nonverbal children.
Acupuncture therapy is safe and can be effectively used to treat pediatric pain. Adverse effects related to acupuncture, including pneumothorax, infection, and cardiac tamponade, have been reported rarely. In reviewing 9 surveys of various adverse effects of acupuncture, Ernst and White5 found that the most common adverse effects were needle pain (1% to 45%) from treatments, tiredness (2% to 41%), and bleeding at the needle insertion site (0.03% to 38%). Feelings of relaxation were reported in as many as 86% of patients. Pneumothorax was rare, occurring 2 times in nearly 250,000 treatments.
Although acupuncture can be a useful adjunct for the treatment of chronic pain in children, awareness of the unique needs of each patient remains essential. Further studies should focus on enhancing therapeutic approaches to pediatric pain and expand on ways to efficiently integrate acupuncture as an effective therapy.
Needlephobia is a commonly encountered problem in acupuncture therapy. Our experience indicates that fear of needling can be minimized by careful preprocedural explanation and demonstration. Children's initial feelings of fear can be drastically reduced after they experience the benefits of treatment. Procedure-related needling discomfort is nonexistent to mild for most children. Overall, pediatric patients report that acupuncture treatment is helpful in improving their conditions.
We thank Ms Margaret Lyons for her help in editing this article.
- Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569-1575.
- NIH Consensus Conference. Acupuncture. JAMA. 1998;280:1518-1524.
- Lin Y-C, Lee A, Kemper K, Berde C. Integrating complementary and alternative medicine in pediatric pain management. Anesthesiology. 1999;91:939.
- Lin Y-C, Bioteau AB, Lee AC. Acupuncture for the management of pediatric pain: a pilot study. Medical Acupuncture. 2002;14(1):45-46.
- Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001;110:481-485.
Dr Yuan-Chi Lin is a Pediatrician, Anesthesiologist, Medical Acupuncturist, and Pain Specialist, and is Director of the Medical Acupuncture Service, Children's Hospital Boston, Harvard Medical School in Boston, Massachusetts.
Yuan-Chi Lin, MD, MPH, FAAP, FAAMA*
Medical Acupuncture Service
Dept of Anesthesiology, Perioperative and Pain Medicine
Children's Hospital Boston
300 Longwood Ave
Boston, MA 02115
Phone: 617-355-4158 • Fax: 617-355-4924
Ms Helen Ly is a Research Assistant at the Medical Acupuncture Service, Dept of Anesthesiology, Perioperative and Pain Medicine at Children's Hospital Boston, Harvard Medical School.
*Correspondence and reprint requests