Research in the cutting-edge treatment of pediatric pain is important because it gives us a clearer picture of how mind-body therapies affect the experience of pain. It also provides the necessary evidence to change the policies that affect what insurance will cover for health care, thereby changing the way that medicine is practiced. The public has increasingly turned to complementary forms of health care in response to the costs and limitations of traditional biomedicine in addressing chronic health problems, the leading cost of health care in the United States today.

The understanding of mind-body relationships that we gain from working with children enables us to develop creative avenues for healing. We need to know how they work, when they work, and in whom they work best. Accordingly, we are currently studying the effects of yoga, acupuncture, massage, and humor in alleviating pain in children. Prevention of pain is also a research priority. In order to prevent chronic pain in adulthood, we are studying gender differences in the development of chronic pain and the effects of puberty, adolescence, anxiety, and feelings of competence on the pain experience.

In the Pediatric Pain Research Laboratory, we study children’s responses to brief sensory experiences of cold, heat, and pressure, documenting their level of tolerance, coping style, pain ratings, and verbal reports of how much it bothered them. We also study the effect of pain management strategies such as distraction, hypnosis, humor, and touch on children’s pain. In this way, we are uncovering mind-body pathways leading to pain vulnerability and pain tolerance. A major part of this process involves monitoring children’s physiological reactions, including a measure of the nervous system control of heart function (cardiac vagal tone), electrical activity of the heart (by electrocardiogram), respiration, pulse, blood pressure, and salivary cortisol (a measure of the body’s response to stress). In addition, we measure pubertal hormone levels, mood and other psychological changes, and physical development. Whenever possible, we try to compare test results between parents and children as a way of identifying familial patterns that may benefit from intervention.

The Pediatric Pain Research Laboratory currently serves as a means of understanding pain in children from a mind-body perspective, through observation. It is also used to teach children mind-body pain-control skills and empower parents in helping their children manage pain. In the future, we plan to create a separate Pediatric Pain Treatment Laboratory where children can practice their newfound skills and develop self-efficacy in managing their pain. Such a lab would have ample space for practicing larger activities, such as yoga or tai chi, and physiological monitors would enable children to get immediate feedback on the effects of their efforts on their bodies.

In addition, we are conducting an oral history project with our patients who give consent, in collaboration with the UCLA Departments of Psychiatry & Biobehavioral Sciences, History, Anthropology, and Sociology. An oral historian is conducting videotaped interviews with our patients in their homes to document their experience of pain and their journey in trying to understand it. As part of this study, the initial medical evaluations of these children are being videotaped (in the Pediatric Pain Clinic and in the Gastroenterology and Neurology Clinics). Sociologists and anthropologists are analyzing the content and process of all home and clinic interviews (i.e., what actually happens when healthcare clinicians talk with patients). This information, as well as information acquired through questionnaires, is intended to shed light on the experience of pain and healing processes in children so that clinicians can know how best to help them.

We also want to learn about pain and other distressing symptoms in children with life-threatening illnesses, including cancer, heart disease, and other conditions. We are studying how children and their parents communicate their distress and needs to the health care team and are developing methods for reducing pain and suffering, and improving the quality of life for these children and their families.

The beauty of all of this research is that it applies both directly and indirectly to everyone: to children with pain, their families, the community, and the healthcare system to which we turn for help.