Research
Research agenda
The overarching mission of the Judith Nan Joy Integrative Medicine Initiative is to create an optimum healing environment at Children's Memorial Hospital. The overall research goal for the Integrative Medicine Initiative is to investigate safe, effective, non-pharmacologic methods to decrease pain and stress in children which will help to optimize their capacity for healing. One unit in the hospital, 6 West, has enrolled their patients in our completed study entitled "Transforming Care at the Bedside," a nursing initiative sponsored by the Robert Wood Johnson Foundation.
The three main modalities we are investigating for pain and stress reduction are:
Energy healing :
Our bodies are always trying to move toward balance and health. Energy healing encourages the flow of our natural energies. The term “energy healing” covers a wide range of styles and techniques which serve to positively affect the human energy field. Hands-on energy work assesses disturbances in the human energy field, and helps to aid the individual’s body to enhance the natural flow of healthy life force. Patients and their families report that energy healing often provides a sense of deep relaxation, and reduction in the experience of pain. Energy healing is also called "touch healing" in our studies. Research is presently being conducted to provide evidence to show how the disturbances and movement of these subtle energies may affect the physical condition of the human body.
Massage therapy:
Massage therapy is a form of hands-on therapy which involves manual manipulation of soft tissue, usually muscle tissue, that increases circulation and lymphatic drainage and decreases muscle tension and stress. Massage therapists apply light to moderate pressure with their hands to different areas of the body that can help the flow of energy in the body. Massage therapy has been reported to increase immune system function, reduce pain, increase muscle relaxation, improve weight gain in premature infants and improve overall sense of well being.
Acupuncture:
Acupuncture is an ancient form of treatment that has been used in China for more than 2000 years. Extremely thin needles are placed in the skin to improve energy flow along energy meridians that correspond to different body organs. Acupuncture has been reported to be effective in reducing pain, nausea and vomiting and headaches.
Another goal is to investigate physiological mechanisms by which beneficial effects of these interventions are mediated, i.e., how do these treatments actually affect the physiology of a patient. These investigations will involve both human and animal subjects. The primary physiological systems we are studying are:
1) The autonomic system (e.g., heart rate, heart rate variability, blood pressure)
2) The endocrine and neurotransmitter systems (e.g., cortisol, catecholamines, serotonin, oxytocin)
3) The immune system (e.g., cytokines, natural killer cells)
4) Gene expression (e.g. changes in gene expression as a result of interventions)
Physiological synchrony:
Healing effects of human interactions, especially those which are perceived as safe and nurturing, may involve resonance or coherence of physiological measures such as heart rate, respiration rate, skin temperature, blood volume, pulse, skin conductance or brain wave activity. We plan to investigate the significance of physiological signals not just in relation to the individual being studied but also in relation to the possible synchronization of signals during the interpersonal interaction taking place. For example, we would like to know whether certain beneficial interactions that appear to have a positive impact on autonomic, hormonal or immune function also show increased patterns of coherence when the physiological signals of the participant and practitioner are analyzed simultaneously.
Current research projects
“Evaluation of the Impact of Energy Healing and Enhanced Interaction Interventions on Length of Hospital Stay, Time to Engraftment, Quality of Life and Symptoms in Pediatric Stem Cell Transplant Patients”
Collaborators: Morris Kletzel MD, David Jacobsohn MD
This study is a preliminary randomized controlled trial evaluating two interventions:
- Energy healing which consists of a trained practitioner gently placing hands on different points on the patient’s body to aid the flow of the body’s energy.
- Enhanced interaction which consists of a trained practitioner spending time with the patient in a quiet pleasant activity like reading a book, playing a game or coloring.
The schedule of intervention sessions is the same for both groups and will start the week before transplant. Each intervention is 20 minutes long, and the sessions end at Day 100 (post transplant). Quality of life and symptom assessments will continue at clinic visits until 12 months post transplant. Poster presented at Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) Annual Meeting, Austin, 2008
“Multi-system Evaluation of Massage Therapy and Relaxation training on HIV+ Adolescents”
Collaborators: Ram Yogev, MD Rob Garofalo, MD, MPH,
This project is supported by an NIH Career Development Award (K23) from the National Center for Complementary and Alternative Medicine (NCCAM) for Dr. Sheila Wang.
This study is a randomized controlled trial of the impact of massage therapy vs relaxation training on immune function, autonomic, behavioral and hormonal systems. Unmedicated HIV+ adolescents will be recruited from Howard Brown Health Center and randomly assigned to a massage therapy or relaxation exercise group. The massage sessions (fully clothed) will be 30 minutes long, twice per week for 12 weeks. The relaxation sessions will follow the same intervention schedule. Participants will be assessed before and after the 12 week interventions and at 3 and 6 month follow-up timepoints.
Relatively low cost CAM therapies, like massage, may have the potential to provide a safe, sustainable form of immunostimulation for HIV+ children and adolescents all over the world. This project utilizes a unique and novel multi-system evaluation of massage therapy that recognizes the complexity of biological systems and the impact of disease on multiple system interactions.
“Evaluation of Massage Therapy on Pain Measures in Children with Chronic Pain”
Collaborators: Santhanam Suresh MD, Suzanne Porfyris APN
Investigating therapies that can reduce pain is a top priority for our program. In this study conducted at the Children's Memorial chronic pain clinic, patients record their pain level using the visual analog scale (VAS) before and after massage therapy interventions. Chronic pain diagnoses include headaches, peripheral neuropathy, abdominal pain, back pain, ear pain, complex regional pain syndrome (CRPS) Type 1, fibromyalgia, ilioinguinal neuralgia, joint arthralgia, and sickle cell disease related pain.
“Evaluation of Energy Healing and Stretching and Breathing Exercises on Level of Fatigue in Pediatric Brain Tumor Patients”
Collaborators: Stewart Goldman MD, Jin-Shei Lai, PhD
This study is a randomized controlled trial evaluating the effects of energy healing vs. stretching and breathing exercises on measures of fatigue. Patients from the neuro-oncology clinic are recruited and randomly assigned to one of the two conditions for 6 weeks. Measures of fatigue are obtained and compared before and after the 6 weekly interventions. Patients then receive the other intervention to assess their responses to both conditions.
“Evaluation of Touch Healing for Reducing Anxiety and Facilitating Ease of IV Insertion”
Collaborators: Kathy Ginder RN, Clinical Manager, Vascular Access Team and VAT Team Staff.
This study is an observational study evaluating whether the presence of an energy healer working with a patient during IV insertion improves patient anxiety and facilitates ease of IV insertion.
Preliminary studies:
One of our initial questions was: How do we optimize the phenomenal technical medical expertise and excellence offered at Children’s Memorial Hospital to provide the most comprehensive healing environment and health care to children?
One of the answer’s may have to do with the quality of touch that we can offer patients. Often touch in the hospital is associated with pain. Does offering safe, nurturing touch have the potential to reduce distress, pain, and discomfort during hospitalization? In our preliminary studies, we asked parents to rate their hospitalized child’s level of distress, pain, tension, discomfort and upset mood on a scale of 1-5 (e.g. 1= very calm, 5= very distressed) before and after massage therapy and touch healing sesions. Parents interested in participating in the study were also asked to rate their levels of symptoms before and after they received these interventions.
Interestingly, parents rated their own distress symptoms higher than parents rated their children’s symptoms. Both parents' and childrens' symptom levels significantly improved after receiving touch healing and massage therapy. Results were presented in a poster session at the APS-SPR Meeting, Toronto 2007, Parent and Child Stress Reduction in the Hospital Setting Following Two Complementary (CAM) Interventions: New Approach to Family Centered Care.
Much of our preliminary work took place on a general pediatric ward in the hospital, 6 West, in collaboration with Unit Director,Yvonne Bilak-Krause RN, BS, MS. Data from 6 West, including ratings from parents and hospital staff participants were analyzed. Touch healing and massage therapy data were pooled because there were no significant differences between conditions. Parent ratings of their hospitalized children, parents themselves and staff all reported significant reductions in stress symptoms following touch healing or massage therapy sessions. Parent, Child and Staff Stress Reduction in the Hospital Setting Following Two Complementary (CAM) Interventions: Support for the Healing Environment.
In collaboration with Dr. Santhanam Suresh and the staff of the pain clinic, adolescent patients were asked to rate their symptoms of distress, pain, tension, discomfort and upset mood before and after massage therapy sessions. All symptom category ratings improved after massage therapy sessions. Poster presented at the Society of Pediatric Anesthesia Winter Meeting, Phoenix, AZ, March 2007. The Role of Massage Therapy in the Management of Chronic Pain in Children: A Pilot Analysis.
Research Director, Dr. Sheila Wang, is a member of the Consortium of Academic Health Centers for Integrative Medicine’s (CAHCIM) Research Work Group. The Consortium’s mission is
to help transform medicine and healthcare through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing and the rich diversity of therapeutic systems.The goal, at its essence, is to make a qualitative difference in people’s health by advocating an integrative model of healthcare, incorporating mind, body and spirit.