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    Laughter may be the best medicine, but a good massage is a close second. Markie Lambert—a 12-year-old patient at St. Jude Children’s Research Hospital—got the best of both worlds.

    Markie and his mother, Margaret, volunteered to be part of an ongoing study using humor and massage conducted by staff in the hospital’s Behavioral Medicine division.

    Researchers created the study to explore whether massage and humor therapy can reduce the distress experienced by patients undergoing stem cell transplants.

    “We’re asking the question about whether brief, positive experiences might serve as a sort of medicine,” says Sean Phipps, PhD, clinical psychologist and lead researcher for the study. “There is some evidence to suggest that a brief, positive experience impacts your ability to tolerate negative experiences. And it may serve as a stress buffer, as well as an antidote against the physical effects of stress.”

    Relaxation station

    Funded by a National Cancer Institute grant, the project is the result of two earlier pilot studies. “We looked at techniques that kids could use during the day and that were transportable to their hospital rooms,” Phipps says. “Of the techniques we tried, the most well-liked and widely used were massage and humor therapy.”

    Margaret can understand why.

    “I’d be sitting up all day and night praying for Markie,” she recalls. “I would go into the relaxation room, put on my headphones and listen to my CD. I was feeling so tense, and as soon as I would start to relax, I would feel more comfortable. The massage therapist had to wake me up once because I’d truly been asleep.”

    Margaret and her son participated in one part of the three-tiered study. In the first group, children receive a massage three times a week along with humor therapy intervention. The second group receives the same interventions, along with massage and relaxation therapy sessions for a participating parent.

    “We bring the parents to a room with a big, soft, comfy recliner with dim lighting,” says Beth Gray, a lead clinical research associate who also serves as the study’s main massage therapist. “We encourage the parents to focus on their breathing and help them to relax each muscle group. Then we encourage them to imagine a safe and peaceful place before beginning the relaxation imagery.” 
    “The relaxation imagery is related to competence in parenting so they can feel more confident in parenting an ill child,” Phipps adds.

    The third group receives standard care. To participate in the study, a patient must be 6 to 18 years of age and undergoing a stem cell transplant from a matched sibling, mismatched family member or an unrelated donor.

    “What we’re doing here is complementary in nature,” Gray says. “It is not meant to replace any of the medical treatments. We want to show some things that could help improve a patient and parent’s quality of life.”

    Ahh, there’s the rub

    Gray is also responsible for coordinating study results from the other participating institutions in Toronto, Canada; Columbus, Ohio; and Philadelphia, Pennsylvania.

    “When I go in the child’s hospital room, I let them know it’s massage time,” she says. “I usually have my CD player with relaxing music. I always ask the patient if it’s okay to have a massage that day. If they say yes, I start with their hands, then arms, legs and feet, shoulder, neck, scalp and back. But it is all based on what the child allows.”

    According to Gray, some children fall asleep and some want to keep an eye on everything. “Sometimes the child may feel nauseated, be in pain or not be in the mood to have a massage,” she says. “We are flexible. We let the children know that they are in charge.”

    For the parents, Beth brings a special table into another room and performs a full-body massage for about 30 minutes. “I take the portable massage table with fresh linens into the parent room, and I also have my CD player with relaxing music and some very light lotion,” Gray says.

    “Parents seem to be so appreciative of the chance to relax because of what they’re going through,” Gray continues. “Parents carry so much stress to stay on top of what they are required to do. This offers them a time to take care of themselves, which is a new concept for many of the parents.”

    Humor me

    Study participants complete forms to determine how they feel before and after the humor and massage intervention, as well as to track their mood, physical well-being and activity levels across the acute phase of transplant.
    “It seemed like Markie rested better and didn’t complain about aches as much after he had a massage,” Margaret recalls. Other study outcomes include monitoring the use of medications for pain and nausea and the number of days spent in the hospital.

    “If some patients require fewer pain medications or get out of the hospital a day sooner, that would more than cover the cost of the interventions,” Phipps says.

    Markie says he really enjoyed having his hands massaged. But his absolute favorite part of the study? The whoopee cushion. “I want to buy one of my own,” he says.

    The whoopee cushion is part of the Comedy Cart—a large, brightly painted box on wheels that travels to each patient’s room. Coordinated by Desirée Louwerse in Behavioral Medicine, the Comedy Cart includes funny glasses, sports bloopers and classic movies like The Three Stooges. A patient can choose an item from the cart or Louwerse will order an item that a patient may think is humorous but is not already included in the cart.

    “We encourage the kids to take a laugh break every day,” Phipps says. “In fact, we recognize that there may be some days when they don’t feel like it, and we stress that those are the days that are best for them to do it. Our research assistants encourage the kids to take items off the cart. Along with this, we try to plant the seed that there are aspects of their own environment that they may find humorous.”

    That may be a funny voice a nurse makes or a humorous mannerism of a doctor. “The goal is to educate the patients and parents about adding laughter to each day,” he adds.

    For Markie, it’s his younger cousin. “She always makes me laugh just by the things she does and the way she dances,” he says.

    “Markie is the one who makes me laugh,” adds his mother.

    From the results of this study, researchers will later be able to study the physiological effects of humor and massage on patients and examine the mechanisms by which these interventions produce positive outcomes.

    “This is really still a preliminary study just to see if it works,” Phipps says. “We’re in the very early stages, but anecdotally, it is being well received.”

    Markie and Margaret were glad to be part of the study, and Gray could see the results. “When they laugh, you know they feel better,” she says.

    Reprinted from summer 2004 Promise magazine.


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