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Pain Relief in Children: It’s Not Just About Drugs Anymore :

September 15, 2017

Editor's note: The 2017 AAP National Conference & Exhibition will take place from Sept. 16-19 in Chicago.

If you had told Cora Breuner, MD, MPH, FAAP, as a medical student that someday she would be singing the praises of integrative medicine, she would have scoffed, saying it was snake oil sold by shysters.

But a bevy of experiences during her medical career have made her a believer.

She was introduced to integrative medicine during medical school when she watched pediatricians teaching patients how to imagine themselves playing in the sand on a beach. During residency, a faculty member from India talked about Ayurvedic healing, which is based on the interconnectedness among the mind, body and spirit.

As a Navy pediatrician, she spent time in Japan where she learned about Buddhism and Shintoism and practices like meditation and mindfulness. Later, she worked in an Afghan refugee camp in Pakistan with extremely limited resources. There she heard discussions about mindfulness and saw how practices such as massage were used for pain relief.

After she did a fellowship in adolescent medicine, Dr. Breuner decided to get more training in mind-body medicine and became a certified hypnotherapist.

She will share how integrative practices can be used to ease pain in pediatric patients during a session titled “Non-Pharmacologic Management of Pain in Children and Adolescents from 7:30-8:15 am Monday (F3008) in McCormick Place West, W178 B and again from 3:00-3:45 pm Tuesday (F4095) in McCormick Place West, W190 A.

Dr. Breuner plans to cover acupuncture, hypnosis, biofeedback, healing touch and mindfulness, and will give brief demonstrations of some of the modalities.

She also will present evidence on the efficacy of non-pharmacologic options to manage pain in children, which she acknowledges is hard to come by due to the difficulties of conducting research on integrative practices in the pediatric population.

However, the evidence is clear when it comes to how many children need pain relief. A 2012 study, for example, showed that 86% of U.S. kids admitted to hospitals experienced pain associated with their visit.

“That is huge,” said Dr. Breuner, a member of the AAP Section on Integrative Medicine and chair of the Committee on Adolescence.

She will spend a few minutes talking about how to get training in integrative modalities and get paid for providing services. For pediatricians who do not have the time or money to become trained providers, she will discuss how to find reputable referrals.

“This is where patients want us to be, and so we have to learn about it,” said Dr. Breuner, professor in the Department of Pediatrics, Adolescent Medicine Division, and adjunct professor orthopedics and sports medicine, Seattle Children's Hospital. “We have to provide it if patients want it. We have to be able to provide them a place to go that’s reputable. And we have to try to get insurance to pay it and if they won’t, we have to try to find philanthropic funds to pay for it as well.”

She also has some advice for those still skeptical of the benefits of integrative medicine.

“Do not roll your eyes when a patient says ‘I want to talk about this stuff. If you don’t want to talk about it, that’s fine, but the second you roll your eyes and say this is all ridiculous, you’ve lost the patient,” Dr. Breuner said. “If you want to keep them in your practice, you have to say, ‘I don’t know a lot about this. I’m not sure I think it’s a great idea, but I want to walk this walk with you until we find someone that you trust and I trust to take care of your child.”

Follow Dr. Breuner on Twitter @corabreuner.

For more coverage of the AAP National Conference & Exhibition visit and follow AAPNews on Twitter and Facebook.

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