Two weeks ago Thursday, I attended a conference for pediatricians at Shriners Hospital in Springfield. It is a welcome annual event, bringing together specialists from Western Massachusetts and Connecticut to talk about subjects ranging from dermatology to rheumatology to neurology.
Not surprisingly, I found my hand going up at the end of three of the morning talks.
The pediatric rheumatologist Laurence Zemel talked about the ever-changing terminology for chronic pain syndromes: fibromyalgia, somatization, functional pain, and so on. He said there is no agreement about cause nor treatment. However, one thing that we do know is that they are all caused by a complex interaction between mind and body. I told him and the audience that experts agree that sensitization of nerves, whether through illness or injury, combined with oversensitivity to the pain signals in the brain, are a likely cause of the pain and discomfort these patients feel.
I explain this to the young people I see, and their families. I say that we are all the time tuning out sensations we don’t need to feel and that they can learn to do the same. Cognitive behavioral therapy, hypnosis, meditation, and biofeedback are good ways to do this. And unlike the drugs that have been tried for these conditions, the side effects of hypnosis and meditation – like relaxation, improvements in self-esteem, increased function – are all good ones!
The well-known pediatric dermatologist Mary Chang gave a thorough review of common skin disorders kids get, including warts. She mentioned every known medical treatment including some expensive and very potent topical drugs like Imiquimod (Aldara), which may commonly cause redness, swelling, and itching and occasionally cause squamous cell carcinoma.
But she did not mention one effective treatment without any side effects. I begin with a simple explanation of what causes warts – to the kids, and their bemused parents:
“What causes warts?” I ask.
If they don’t know, I explain “Viruses, just like the viruses which cause colds”
“And what gets rid of colds?” I continue.
“Medicines,” they often say.
“Well if you didn’t have a medicine for a cold, would you, like, die,” I ask?
“No” they laugh.
“No!” I say. “That’s because our OWN BODIES kill the cold viruses! Same goes for warts.”
By this time, smart parents, and older kids sometimes guess it’s the immune system that does the work. I then talk about how one can imagine those white blood cells of the immune system going to work like soldiers in one of the violent video games they often play to kill the wart viruses, or, more peaceably imagine there’s a polar bear licking them off, as a boy with two dozen warts over his eyelids and around his nostrils and lips was able to do years ago.
Mental imagery for warts has been proven as effective for wart eradication as liquid nitrogen, the standard office treatment. And it’s a lot less painful and more fun! Dr. Chang agreed that the mind is a powerful thing, adding the time-honored treatment: offering the child $5 if she got rid of the wart on her own. There’s some truth to that, but my method is certainly more of a teaching tool about the power of self-regulation, giving them a skill they can use in the future. And it’s evidence based.
Headaches were the subject of the last talk of the morning, given by the pediatric neurologist Jennifer Madan Cohen. It was an informative comprehensive talk focusing on pediatric migraines, but she did not talk about the treatment for which there is the most evidence: behavioral.
My mentor Karen Olness published a placebo controlled trial from the University of Minnesota in 1980 comparing hypnosis to Inderal, the medication still often used to prevent migraines. It was a prospective trial with a cross over design, meaning that the group being treated with one of the modalities, like the medicine, and still not better would then receive the other treatment. It’s a rigorous study. Children got better with hypnosis versus the medicine in both parts of the study. Since then, there is been lots of research confirming Dr. Olness’sfindings.
Dr. Cohen talked about the ways in which migraines are diagnosed. In addition to verbal descriptions (often difficult for young children), I have them draw pictures. This wasn’t my idea but neurologists’ who wrote articles about having their “migraineurs” (I dislike this word as I dislike any words that identify a patient by her disorder) draw their headaches to help diagnose them. Then pediatric neurologists followed suit.
But we who have the privilege of doing clinical hypnosis with kids take it a step further. I’ll have a young person draw a picture of himself with the headache, then a picture of what he looks like WITHOUT the headache – usually when he is doing something fun and/or relaxing. They use the imagery of themselves feeling well to alter the image of the headache in the hypnosis session. They may change the hammers banging on their head to harmless rubber, or create a special helmet to protect themselves. Of course, I will address sources of anxiety that often trigger the anxiety, as well as other lifestyle factors.
There have been many hundreds of medicines used for headaches. All except three or four are not approved by the FDA for this indication. On the other hand, hypnosis and biofeedback has been proclaimed a safe and effective treatment for headaches according to the standards of the Cochrane Data Base which rates all treatments in medicine based on an analysis of all the good scientific studies that have been done.
Shouldn’t we be using these treatments as our FIRST treatment for pediatric headaches, I asked, and not as some alternative last resort?