At age 17, Victoria Rust came down with pancreatitis, suffering waves of terrible pain that kept her hospitalized for much of last year.
When the only medicine that was helping her caused stomach bleeding and had to be stopped, a doctor at Children's National Medical Center suggested an unconventional treatment: acupuncture.
Rust and her mother agreed to let a physician at Children's Hospital place thin needles into her stomach and other spots; within minutes, the West Virginia high school student felt much better.
"I was mellowed," she said. "The pain didn't come." The needles turned out to be no big deal.
Children and needles may seem an unusual pairing, but doctors say a growing number of families are choosing acupuncture, in which thin needles are inserted into specific points on the body and manipulated by hand or with electrical stimulation with the goal of restoring and maintaining health. It's often performed when standard medicines or therapies don't work, have too many side effects or need a boost.
Acupuncture is increasingly being prescribed and performed by physicians in such traditional Western hospital settings as Children's. Last year, an analysis in the journal Pediatrics concluded that acupuncture was safe for kids "when performed by appropriately trained practitioners."
Officials at pediatric hospitals estimate that at least a third of U.S. pain centers for children offer acupuncture alongside traditional treatments. The federal government's National Health Interview Survey, which last asked about acupuncture in 2007, estimated that about 150,000 children were receiving the needle treatment annually for conditions such as pain, migraine and anxiety.
"People will often bring it up before I bring it up," said Jennifer Anderson, an anesthesiologist at Children's who is also a licensed acupuncturist. "I often treat patients with chronic issues" such as nausea and abdominal pain. "It's very helpful."
The American Academy of Pediatrics acknowledges that more young patients are undergoing acupuncture and other alternative therapies, and an article in its journal, Pediatrics, says a growing number of pediatric generalists and subspecialists are offering these services. It also urges doctors to seek information on such practices when families express interest, evaluate them on their scientific merits and pass information to parents.
Anderson and other doctors said acupuncture is an important and safe adjunct to traditional treatments for children. A 2008 review of studies published in the Journal of Pediatric Hematology/Oncology cited evidence that acupuncture is effective for preventing nausea after surgery in children and for alleviating pain. It said there's some evidence that it can help children with allergy symptoms but pointed out that more study is needed.
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Anderson said she often does two to three treatments a week at first on a child, eventually tapering visits to once a month. Stephen Cowan, a New York pediatrician who is also a certified medical acupuncturist, said Western medicine is great for acute problems that often afflict kids, such as ear infections. But he said acupuncture can be extremely helpful for such chronic or difficult-to-treat problems as attention-deficit hyperactivity disorder and asthma.
He related the case of a year-old boy who came to the hospital at 3 a.m. with an asthma attack. A nebulizer treatment wasn't working, Cowan said, so he decided to try acupuncture. The boy reacted calmly, and his pulse-oximeter readings went up to 95 percent, which is within the normal range.
"I'm not advocating replacing Western treatments. I'm asking: Where can [acupuncture] serve best in the system of medicine pervasive in our culture?" said Cowan, author of the ADHD book "Fire Child, Water Child." "Acupuncture doesn't cure infection. But I find it very useful in preventive care," such as alleviating stress, he said.
Sarah Rebstock, clinical director of the Pediatric Pain Medicine Outpatient Clinic at Children's Hospital, said she prescribes acupuncture as an adjunct to other traditional care mainly for pain that seems disproportionate to the condition or that lasts for more than about six weeks. Anderson often performs the treatment, and children get medications or other Western therapies as well.
Acupucturists say needles are the biggest concern among parents and children; Cowan said some children are so resistant when the process is described that they won't go forward with treatment.
"Some constitutional temperaments are more apt to be afraid of needles," he said. "These children require a lot of time and trust before they're willing to try it."
Acupuncturists often develop ways to ease children's fears about the needles. "It's all in the way it's presented to a kid," Cowan said. "I describe them as little hairs. Sometimes, I ask kids to do it to me first. "
Angela Gabriel, a licensed acupuncturist at the Center for Integrative Medicine at George Washington University Medical Center, said some young children are fearful of needles, but "by 8, 9 or 10, a lot of kids think it's cool."
Rust, who travels 2 1/2 hours to Children's from her house in West Virginia, said needles were not an issue for her, since she has suffered from gastroinestinal issues her whole life and has endured many needle sticks. She was nervous about acupuncture needles going into her stomach and ears, but she was eager to get some relief and decided to try it.
Her mother, Paula Rust, said acupuncture reduced her daughter's pain and allowed her to relax. "It was the one thing she would totally relax with," she said. "To me, that's kind of incredible."
The only problem is that the relief didn't last.
"While the needles are there, it's wonderful," Victoria Rust said of the treatments, which lasted about half an hour. Then, the pain gradually returned, sometimes as soon as half an hour after a treatment.
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Some studies and acupunturists suggest that such short-term relief isn't typical and that the effects of acupuncture usually last weeks or more. According to the American Academy of Medical Acupuncture, initial treatments may bring only short-term relief, but effects of treatments are cumulative and the aim is a thorough resolution of the problem, or at least a reduction of discomfort over the long term.
But Anderson said acupuncture doesn't work at all in some patients.
She estimated it helps about 70 percent of the patients she treats. For some, it may not reduce their pain, though it may decrease stress or anxiety.
While relatively few acupuncture complications have been reported to the Food and Drug Administration, there have been some from inadequate sterilization of needles and improper delivery of treatments. The FDA requires needles to be sterile, nontoxic and labeled for single use by qualified practitioners.
Physician acupuncturists, in addition to their medical training, get instruction in acupuncture.
Non-physician practitioners lack medical degrees, but many have training validated by the National Certification Commission for Acupuncture and Oriental Medicine.
Stephen Barrett, a retired psychiatrist who runs the Web site Quackwatch.org, said there has been very little research on what happens physically when someone undergoes acupuncture. He also said there's a danger that patients may be misdiagnosed if they seek help only from a non-physician acupuncturist.
Many health insurance plans don't cover acupuncture, because it is nontraditional, although some do. Fees vary widely and can be more than $65 a visit.
West Virginia's Medicaid program paid for the treatments for Victoria Rust, who went to Children's for her underlying illness because her family doctor felt Children's would provide the best care. Paula Rust said she is glad that acupuncture was also available and that it was performed by a physician in whom "you feel there's that trust factor."
Ungar is the medical writer at the Courier-Journal in Louisville.