Complementary (ALTERNATIVE) Techniques:

Principles that guide the use of complementary techniques in the management of chronic pain in children include

Recognition that education of children and their parents about the multi-dimensional nature of pain and its treatment is crucial to the success of complementary approaches. Without the understanding of the role that complementary treatments can play and the mechanism by which they may exert their effects, children and parents may refuse them, due to concern that health care providers do not see their pain as "real".

A rehabilitative approach that emphasizes improving the child and families ability to cope with the chronic condition and decreasing pain related to emotional and behavioral conditions.

The recognition that interventions need to be tailored to the child's individual characteristics not just to his/her specific conditions.

An orientation toward prevention where possible by anticipating and aggressively managing acute pain, pain exacerbation and other stressors as they occur with in the context of a chronic pain condition.

Complementary techniques:

Acupuncture: Ancient Chinese medical technique involving stimulation of specific skin location by a variety of methods. Example: Needle insertion at acupuncture point.

Art therapy: Use of creative arts to modify pain and mood. Example: having children use arts and craft as a means to express feelings/concerns about their pain and its treatment.

Behavioral management: Use of operant and classical conditioning methods to manage pain-related disability. Examples: Rewarding a child's efforts to increase activities and comply with treatments; desensitizing a child to aversive aspects of medical treatment.

Breathing: Modulation of breathing to increase sensation of relaxation and exercises to distract the child from pain. Example: Deep breaths, "blowing away pain".

Biofeedback: Provision of auditory and/or visual feedback related changes in involuntary bodily responses to assist with the modification of these responses. Examples: Heart rate, galvanic skin response (GSR), hand temperature, and electromyography (EMG).

Cold therapy: Use of cold to provide local analgesia, typically for acute pain. Examples: Ice massage, vapocoolant sprays, cold packs.

Cognitive therapy: Modification of cognitions that exacerbate pain and mood. Examples: Reducing negative, "catastrophizing cognitions", increasing the child's positive self- statements about his/her abilities to cope.

Distractions: Use of any variety of methods that absorb the child's attention methods to reduce the child's focus on pain and pain treatment. Examples: bubble blowing, singing, videogames, party blowers, pinwheels.

Education: Providing age appropriate information to children about their pain, and the methods used to treat pain. Example: Explaining to a school age child that they can rub the injection site "close to the pain gate" before and after the shot.

Exercise: Prescribed activities to increase the child's functional capacities and reverse any pain related deconditioning. Examples: stretching, strengthening, flexibility, aerobic and range of motion exercises.

Heat Therapy: Use of heat to relieve muscle spasm, joint stiffness and increase local metabolism. Example: Hot packs, hydrotherapy, ultrasound.

Hypnosis: Induction of an altered state of consciousness, wherein the child is suggestible to alterations of sensation and perception. Examples: the child with CPRS may imagine herself turning off a pain switch to reduce sensation in an affected limb.

Massage and touch: Application of touch or force to soft tissues, usually without causing movement or change in joint position. Examples: Rubbing the site of a needle injection, stroking/ kneading sore muscles.

Mental Imagery: A multi-sensory representation of experience. Examples: Having children imagine themselves in a pleasant place doing some thing they really like to do, involving as many senses as possible in the image.

Music therapy: Use of music to modify mood and distract the child from pain. Examples: having the child sing a song or listen to favorite music.

Play therapy: Use of play to desensitize or educate a child about their plan and painful medical procedures. Examples: Play with medical props supervised by a play therapist or child specialist.

Relaxation: Techniques that reduce the stress response and produce feelings of mental calmness, usually involving a repetitive stimulus. Examples: Progressive muscle relaxation, meditation, autogenics.

TENS: Use of electrical stimulation that can be applied to the skin at different rates and intensities, to relieve pain. Examples: Positioning of TENS unit over muscle in spasm.