Efficacy of Traditional, Complementary, and Integrative Medicine in Pain and Psychological Distress Management for Pediatric Palliative Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Context: Traditional, complementary, and integrative medicine (TCIM) is being increasingly used to manage symptoms in patients with palliative needs. However, there is a lack of evidence to guide its use in the pediatric palliative care (PPC) setting.

Objectives: This study aimed to synthesize and evaluate the current evidence on the effectiveness of TCIM in reducing pain and psychological distress in PPC.

Methods: Four English electronic databases were searched for randomized controlled trials (RCTs) published between January 2000 and August 2023. The standardized mean difference (SMD) was used to report the pooled magnitude of the treatment effect. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the quality of the evidence for each treatment outcome.

Results: Thirty RCTs were included. The interventions were massage (n = 9), music therapy (n = 6), hypnosis (n = 3), acupuncture, aromatherapy, and other TCIM modalities. Compared with the control interventions, music therapy significantly decreased pain (SMD: -1.07; 95% CI: -1.64 to -0.50; P < 0.05; I² = 72%) and relieved anxiety (SMD: -0.75; 95% CI: -1.35 to -0.15; P < 0.05; I² = 74%); massage significantly decreased pain (SMD: -0.74; 95% CI: -1.46 to -0.02; P < 0.05; I² = 83%) and relieved anxiety (SMD: -0.61; 95% CI: -1.21 to -0.01; P < 0.05; I² = 71%). Hypnosis had significant effects on procedure-related anxiety, pain, and behavioral distress management (P < 0.05). The quality of evidence was rated as "moderate" for the efficacy of music therapy in alleviating pain and anxiety and "low" for the efficacy of all of the other interventions.

Conclusions: Existing evidence supports the therapeutic benefits of music therapy, massage, and hypnosis on relieving pain and anxiety symptoms in the PPC setting, though the evidence is of low-to-moderate quality.