Why did 16 of the children choose not to participate or persist in participating in recommended CAM therapy? One possible explanation is that they lacked confidence that a new therapy will work when many others have failed to work and believed that their pain was a different and intractable problem that doctors did not know how to treat and that they could not manage themselves. Another is that they were not given the opportunity to observe others; were not given sufficient reinforcement from family or other significant contacts for participation; and were not helped to overcome any perceived barriers to access.