Children with cystic fibrosis benefit from massage therapy. On pins and needles? Pediatric pain patients' experience with acupuncture. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. Acupuncture against chemotherapy-induced nausea and vomiting in pediatric oncology Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: the importance of silence Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain. A randomized trial to test the effectiveness of art therapy for children with asthma. Interactive Music as a Treatment for Pain and Stress in Children During Venipuncture: A Randomized Prospective Study Behavioral intervention to reduce child and parent distress during venipuncture. Quantification of the Effects of Listening to Music as a Noninvasive Method of Pain Control A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients Safety and Efficacy of Acupuncture in Children: A Review of the Evidence Children with Cancer and Blood Diseases Experience Positive Physical and Psychological Effects from Massage Therapy Juvenile rheumatoid arthritis: benefits from massage therapy. [Role of interactive music in oncological pediatric patients undergoing painful procedures]. Art therapy as support for children with leukemia during painful procedures. Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. CORTISOL DECREASES AND SEROTONIN AND DOPAMINE INCREASE FOLLOWING MASSAGE THERAPY Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. Clinical Hypnosis in the Alleviation of Procedure-Related Pain in Pediatric Oncology Patients Massage therapy for symptom control: outcome study at a major cancer center. The effect of gender and ethnicity on children's attitudes and preferences for essential oils: a pilot study. The effects of interactive music therapy on hospitalized children with cancer: a pilot study. Creative Arts Therapy Improves Quality of Life for Pediatric Brain Tumor Patients Receiving Outpatient Chemotherapy Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology - a randomized multicenter crossover pilot trial. Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: results of a placebo-controlled double-blind trial. Children with asthma have improved pulmonary functions after massage therapy. Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. Randomized Controlled Trials of Pediatric Massage: A Review
OBJECTIVE To measure the effects of parents giving massage therapy to their children with cystic fibrosis to reduce anxiety in parents and their children and to improve the children 's mood and peak air flow readings . METHODS Twenty children ( 5 - 12 years old ) with cystic fibrosis and their parents were r and omly assigned to a massage therapy or a reading control group . Parents in the treatment group were instructed and asked to conduct a 20-minute child massage every night at bedtime for one month . Parents in the reading control group were instructed to read for 20 minutes a night with their child for one month . On days 1 and 30 , parents and children answered questions relating to present anxiety levels and children answered questions relating to mood , and their peak air flow was measured . RESULTS Following the first and last massage session , children and parents reported reduced anxiety . Mood and peak air flow readings also improved for children in the massage therapy group . CONCLUSIONS These findings suggest that parents may reduce anxiety levels by massaging their children with cystic fibrosis and their children may benefit from receiving massage by having less anxiety and improved mood , which in turn may facilitate breathing INTRODUCTION Despite its increasing use as a complementary therapy to treat pain , acupuncture is rarely considered by pediatricians , in part due to perceptions that it will not be acceptable to pediatric patients . We wished to describe pediatric pain patients ' experience with acupuncture treatment for chronic pain . DESIGN Retrospective case series . METHODS Subjects were pediatric pain patients referred by the Pain Treatment Service at Children 's Hospital in Boston , who went to a pediatric acupuncturist .  A research assistant not involved in the patient 's care conducted the survey by telephone . Data were analyzed qualitatively and descriptively . RESULTS Of 50 eligible patients , 47 families were reached by telephone ; all agreed to be interviewed . Patients had a median age of 16 years at the time of referral , 79 % were female , and 96 % were white . The most common three diagnoses were migraine headache ( n = 7 ) , endometriosis ( n = 6 ) , and reflex sympathetic dystrophy ( n = 5 ) . Patients had a median of 8 treatments ( range : 0 - 60 ) within 3 months ( range : 0 - 48 months ) ; 85 % of families paid out-of-pocket . Acupuncture therapies included needle insertion ( 98 % ) , heat/moxa ( 85 % ) , magnets ( 26 % ) , and cupping ( 26 % ) . Most patients and parents rated the therapy as pleasant ( 67 % children/60 % parents ) , and most ( 70 % children/59 % parents ) felt the treatment had helped their symptoms ; only 1 said that treatment made symptoms worse . CONCLUSION Pediatric patients with chronic , severe pain found  acupuncture treatment pleasant and helpful . Additional , prospect i ve studies are needed to quantify the costs and effectiveness of acupuncture treatment for pediatric pain UNLABELLED It has been postulated that sensory stimulation ( acupuncture ) affects the cardiovascular system via the autonomic nervous system . Previously , skin temperature , thermography , plethysmography and blood pressure changes have been used in evaluation of sympathetic nerve activity following acupuncture . By using power spectral analysis , the low frequency and high frequency components of heart rate variability can be calculated reflecting the sympathetic and parasympathetic activity . The purpose of this study was to investigate to what extent acupuncture applied into the thenar muscle and into the cavum concha of the ear induced changes in the sympathetic and /or parasympathetic nervous system in healthy subjects . MATERIAL S AND METHODS Twelve healthy volunteers , six men and six women , mean age 34.4 ( range 23 - 48 ) participated in three balanced , r and omly distributed sessions . At an individual initial visit the 12 volunteers were introduced to the needle sensation by having a needle inserted into the point LI 11 . The needle sensation was evoked and the subject was trained to identify the characteristic needle sensation . The introduction was followed by three test sessions . SESSION A A short acupuncture needle , ( Seirin no 3 , ∅0.20x15 mm ) was inserted perpendicular into the earpoint , Lu 1 , in the left inferior hemi-conchae . SESSION B An acupuncture needle ( Hwato , ∅0.30x30 mm ) was inserted perpendicular into the Hegu point ( LI 4 ) in the middle of the right dorsal thenar muscle . SESSION C An acupuncture needle ( Hwato , ∅0.30x30 mm ) was inserted perpendicular superficially into the skin overlying the Hegu point on the left h and . Results . Stimulation of the ear induced a significant increase in the parasympathetic activity during the stimulation period of 25 min ( P<0.05 ) and during the post-stimulation period of 60 min ( P<0.05 ) . No significant changes were observed in either the sympathetic activity , blood pressure or heart rate . Stimulation of the thenar muscle result ed in a significant increase in the sympathetic and the parasympathetic activity during the stimulation period ( P<0.01 ) and during the post-stimulation period ( P<0.01 and P<0.001 , respectively ) . A significant decrease in the heart rate frequency ( P<0.05 ) at the end of the post-stimulation period was also demonstrated . The superficial needle insertion into the skin overlaying the right thenar muscle caused a pronounced balanced increase in both the sympathetic and parasympathetic activity during the post stimulation period of 60 min ( P<0.01 ) while no changes were observed during the stimulation period . CONCLUSION It is indicated that sensory stimulation ( acupunctura ) in healthy persons is associated with changed activity in the sympathetic and parasympathetic nervous system depending on site of stimulation and period of observation Goals In this multicenter crossover study , our aim was to evaluate the efficacy and acceptance of acupuncture as a supportive antiemetic approach during highly emetogenic chemotherapy in pediatric oncology . Patients and methods Eleven children receiving several courses of highly emetogenic chemotherapy for treatment of solid tumors were included . R and omization allocated patients to start chemotherapy either with antiemetic medication plus acupuncture or antiemetic medication alone . During all study courses , patients continued to receive their programmed and additional antiemetic medication as needed . Acupuncture was given at day 1 of chemotherapy and at subsequent days on patient ’s dem and . The amount of baseline and additional antiemetic medication during chemotherapy was documented . Patients maintained a daily diary of vomiting episodes and completed an evaluated nausea score at the end of every course . Their body weight was taken before and after a chemotherapy course . Main results Twenty-two courses with or without acupuncture were compared . The benefits of acupuncture in adolescents with respect to the reduction of additional antiemetic medication were observed . Acupuncture enabled patients to experience higher levels of alertness during chemotherapy and reduced nausea and vomiting . Except for needle pain , no side effects were noted . Patient ’s acceptance of acupuncture was high . Conclusion Our data indicate that acupuncture might reduce antiemetic medication and episodes of vomiting in pediatric oncology Objective : To assess the potential clinical use , particularly in modulating stress , of changes in the cardiovascular and respiratory systems induced by music , specifically tempo , rhythm , melodic structure , pause , individual preference , habituation , order effect of presentation , and previous musical training . Design : Measurement of cardiovascular and respiratory variables while patients listened to music . Setting : University research laboratory for the study of cardiorespiratory autonomic function . Patients : 12 practising musicians and 12 age matched controls . Interventions : After a five minute baseline , presentation in r and om order of six different music styles ( first for a two minute , then for a four minute track ) , with a r and omly inserted two minute pause , in either sequence . Main outcome measures : Breathing rate , ventilation , carbon dioxide , RR interval , blood pressure , mid-cerebral artery flow velocity , and baroreflex . Results : Ventilation , blood pressure , and heart rate increased and mid-cerebral artery flow velocity and baroreflex decreased with faster tempi and simpler rhythmic structures compared with baseline . No habituation effect was seen . The pause reduced heart rate , blood pressure , and minute ventilation , even below baseline . An order effect independent of style was evident for mid-cerebral artery flow velocity , indicating a progressive reduction with exposure to music , independent of style . Musicians had greater respiratory sensitivity to the music tempo than did non-musicians . Conclusions : Music induces an arousal effect , predominantly related to the tempo . Slow or meditative music can induce a relaxing effect ; relaxation is particularly evident during a pause . Music , especially in trained subjects , may first concentrate attention during faster rhythms , then induce relaxation during pauses or slower rhythms A prospect i ve controlled trial was conducted to compare the efficacy of an analgesic cream ( eutectic mixture of local anesthetics , or EMLA ) with a combination of EMLA with hypnosis in the relief of lumbar puncture-induced pain and anxiety in 45 pediatric cancer patients ( age 6 - 16 years ) . The study also explored whether young patients can be taught and can use hypnosis independently as well as whether the therapeutic benefit depends on hypnotizability . Patients were r and omized to 1 of 3 groups : local anesthetic , local anesthetic plus hypnosis , and local anesthetic plus attention . Results confirmed that patients in the local anesthetic plus hypnosis group reported less anticipatory anxiety and less procedure-related pain and anxiety and that they were rated as demonstrating less behavioral distress during the procedure . The level of hypnotizability was significantly associated with the magnitude of treatment benefit , and this benefit was maintained when patients used hypnosis independently BACKGROUND Art therapy has been used to help children cope with chronic illness but has not been specifically tested with children who have asthma . OBJECTIVE To test an art therapy intervention in a r and omized controlled trial in children with asthma . METHODS Twenty-two children with asthma were r and omized to an active art therapy or wait-list control group . Those in the active art therapy group participated in 60-minute art therapy sessions once a week for 7 weeks . Sessions included specific art therapy tasks design ed to encourage expression , discussion , and problem-solving in response to the emotional burden of chronic illness . Measures taken at baseline , immediately after , and 6 months after the final art therapy session included the Formal Elements Art Therapy Scale applied to the Person Picking an Apple from a Tree assessment , the parent and child versions of the Pediatric Quality of Life Asthma Module , and the Beck Youth Inventories . Those children assigned to the wait-list control group completed all evaluations at the same intervals as the children receiving art therapy but did not receive the art therapy interventions . RESULTS Score changes from baseline to completion of art therapy indicated ( 1 ) improved problem-solving and affect drawing scores ; ( 2 ) improved worry , communication , and total quality of life scores ; and ( 3 ) improved Beck anxiety and self concept scores in the active group relative to the control group . At 6 months , the active group maintained some positive changes relative to the control group including ( 1 ) drawing affect scores , ( 2 ) the worry and quality of life scores , and ( 3 ) the Beck anxiety score . Frequency of asthma exacerbations before and after the 6-month study interval did not differ between the 2 groups . CONCLUSION This was the first r and omized trial demonstrating that children with asthma receive benefit from art therapy that includes decreased anxiety and increased quality of life Objective : The experience of venipuncture is seen by children as one of the most fearful experiences during hospitalization . Children experience anxiety both before and during the procedure . Therefore , any intervention aim ing to prevent or reduce distress should focus on the entire experience of the procedure , including waiting , actual preparation , and conclusion . This study was design ed to determine whether the presence of musicians , who had attended specific training to work in medical setting s , could reduce distress and pain in children undergoing blood tests . Methods : Our sample population was composed of 108 unpremedicated children ( 4–13 years of age ) undergoing blood tests . They were r and omly assigned to a music group ( n = 54 ) , in which the child underwent the procedure while interacting with the musicians in the presence of a parent or to a control group ( n = 54 ) , in which only the parent provided support to the child during the procedure . The distress experienced by the child before , during and after the blood test was assessed with the Amended Form of the Observation Scale of Behavioral Distress , and pain experience with FACES scale ( Wong Baker Scale ) only after the venipuncture . Results : Our results show that distress and pain intensity was significantly lower ( p < .001 ; p < .05 ) in the music group compared with the control group before , during , and after blood sampling . Conclusions : This controlled study demonstrates that songs and music , performed by “ professional ” musicians , have a beneficial effect in reducing distress before , during , and after blood tests . This study shows , moreover , that the presence of musicians has a minor , but yet significant , effect on pain due to needle insertion This study investigated a behavioral intervention incorporating parent coaching , attentional distraction , and positive reinforcement to control child distress during invasive cancer treatment . Children ( N = 23 ) requiring physical restraint to complete venipuncture were alternately assigned to either a behavioral intervention or an attention control condition .  Child distress behaviors were recorded , and self-reports of parent , child , and nurse distress were obtained . Parent and nurse also rated child distress . Results of planned comparisons indicate that observed child distress , parent-rated child distress , and parent ratings of his/her own distress were significantly reduced by behavioral intervention and were maintained across the course of three intervention trials . The use of physical restraint to manage child behavior was also significantly reduced . Child self-reported pain and nurse ratings of child distress were not significantly affected This study quantified the effects of listening to music as a noninvasive nursing method of  pain control . The effects of soothing and stimulating music on pain and tactile thresholds , heart rate , and blood pressure were determined on healthy female volunteers ( N = 10 ) in a laboratory setting . Data were analyzed by ANOVA for repeated measures and post hoc comparison tests . Soothing music significantly elevated pain thresholds but not tactile thresholds . Stimulating music significantly elevated pain thresholds as well as tactile thresholds . Neither stimulating nor soothing music had a significant effect on autonomic activity . Based on the results of this laboratory study and other studies , the effects of listening to music on people in pain warrants further examination ABSTRACT Venepuncture for blood sampling can be a distressing experience for a considerable number of children . A prospect i ve controlled trial was conducted to compare the efficacy of a local anaesthetic ( EMLA ) with a combination of EMLA with self‐hypnosis in the relief of venepuncture‐induced pain and anxiety in 45 paediatric cancer out patients ( age 6–16 years ) . A secondary aim of the trial was to test whether the intervention will have a beneficial effect on  parents ’ anxiety levels during their child ’s procedure . Patients were r and omized to one of three groups : local anaesthetic , local anaesthetic plus hypnosis , and local anaesthetic plus attention . Results confirmed that patients in the local anaesthetic plus hypnosis group reported less anticipatory anxiety , and less procedure‐related pain and anxiety , and were rated as demonstrating less behavioural distress during the procedure than patients in the other two groups . Parents whose children were r and omized to the local anaesthetic plus hypnosis condition experienced less anxiety during their child ’s procedure than parents whose children had been r and omized to the other two conditions . The therapeutic benefit of the brief hypnotic intervention was maintained in the follow‐up . The present findings are particularly important in that this study was a r and omized , controlled trial conducted in a naturalistic medical setting . In this context , convergence of subjective and objective outcomes was reached with large effect sizes that were consistently supportive of the beneficial effects of self‐hypnosis , an intervention that can be easily taught to children , is noninvasive and poses minimal risk to young patients and their parents Acupuncture has been used therapeutically in China for thous and s of years and is growing in prominence in Europe and the United States . In a recent review of complementary and alternative medicine use in the US population , an estimated 2.1 million people or 1.1 % of the population sought acupuncture care during the past 12 months . Four percent of the US population used acupuncture at any time in their lives . We review ed 31 different published journal articles , including 23 r and omized controlled clinical trials and 8 meta- analysis / systematic review s. We found evidence of some efficacy and low risk associated with acupuncture in pediatrics . From all the conditions we review ed , the most extensive research has looked into acupuncture 's role in managing postoperative and chemotherapy-induced nausea/vomiting . Postoperatively , there is far more evidence of acupuncture 's efficacy for pediatrics than for children treated with chemotherapy . Acupuncture seems to be most effective in preventing postoperative induced nausea in children . For adults , research shows that acupuncture can inhibit chemotherapy-related acute vomiting , but conclusions about its effects in pediatrics can not be made on the basis of the available published clinical trials data to date . Besides nausea and vomiting , research conducted in pain has yielded the most convincing results on acupuncture efficacy . Musculoskeletal and cancer-related pain commonly affects children and adults , but unfortunately , mostly adult studies have been conducted thus far . Because the manifestations of pain can be different in children than in adults , data can not be extrapolated from adult research . Systematic review s have shown that existing data often lack adequate control groups and sample sizes . Vas et al , Alimi et al , and Mehling et al demonstrated some relief for adults treated with acupuncture but we could not find any well-conducted r and omized controlled studies that looked at pediatrics and acupuncture exclusively . Pain is often unresolved from drug therapy , thus there is a need for more studies in this setting . For seasonal allergic rhinitis , we review ed studies conducted by Ng et al and Xue et al in children and adults , respectively . Both population s showed some relief of symptoms through acupuncture , but questions remain about treatment logistics . Additionally , there are limited indications that acupuncture may help cure children afflicted with nocturnal enuresis . Systematic review s show that current published trials have suffered from low trial quality , including small sample sizes . Other areas of pediatric afflictions we review ed that suffer from lack of research include asthma , other neurologic conditions , gastrointestinal disorders , and addiction . Acupuncture has become a dominant complementary and alternative modality in clinical practice today , but its associated risk has been question ed . The National Institutes of Health Consensus Statement states “ one of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted procedures for the same conditions . ” A review of serious adverse events by White et al found the risk of a major complication occurring to have an incidence between 1:10,000 and 1:100,000 , which is considered “ very low . ” Another study found that the risk of a serious adverse event occurring from acupuncture therapy is the same as taking penicillin . The safety of acupuncture is a serious concern , particularly in pediatrics . Because acupuncture 's mechanism is not known , the use of needles in children becomes question able . For example , acupoints on the vertex of infants should not be needled when the fontanel is not closed . It is also advisable to apply few needles or delay treatment to the children who have overeaten , are overfatigued , or are very weak . Through our review of pediatric adverse events , we found a 1.55 risk of adverse events occurring in 100 treatments of acupuncture that coincides with the low risk detailed in the studies mentioned previously . The actual risk to an individual patient is hard to determine because certain patients , such as an immunosuppressed patient , can be predisposed to an increased risk , acupuncturist 's qualifications differ , and practice s vary in certain parts of the world . Nevertheless , it seems acupuncture is a safe complementary/alternative medicine modality for pediatric patients on the basis of the data we review ed Background : Previous research has shown positive effects from massage therapy ( MT ) for premature infants and for children with asthma , arthritis , and other illnesses . Although these effects have been demonstrated , MT research on children with cancer and blood disease is needed . Purpose and Setting : The present study , conducted at the Cancer Center , Sh and s Hospital , at the University of Florida , Gainesville , measured the physical and psychological effects of MT on pediatric oncology and hematology patients . The participants were 30 children with cancer or blood disease , ages 6 months to 17 years . Research Design : This r and omized , non-blinded prospect i ve study used measures of physical health and mental wellbeing that were completed before , during , and after four MT sessions were implemented . Descriptive statistics , one-way between-subjects analysis of variance , and an independent- sample s t-test were used to analyze the data . Intervention : The treatment group received 20-minute sessions of Swedish MT once daily for approximately 4 days ( in patients ) , or once weekly for approximately 4 weeks ( out patients ) ; the control group received no MT . Results : Between-groups analyses indicated significant psychological improvements for the MT group on state anxiety ( F1,58 = 16.79 , p < 0.000 ) , trait anxiety ( F1,58 = 3.95 , p < 0.000 ) , and emotional state ( F1,238 = 42.39 , p < 0.001 ) ] . Between-groups analyses indicated significant physical improvements for the MT group on muscle soreness ( F1,238 = 38.96 , p < 0.001 ) , discomfort ( F1,238 = 50.16 , p < 0.001 ) , respiratory rate ( F1,237 = 22.47 , p < 0.000 ) ] , and overall progress ( t28 = 25.55 , p < 0.000 ) . No significant differences were found between groups on parent-completed ratings of their child ’s physical or psychological health , pulse rate , or blood pressure . Conclusions : In children with cancer and blood diseases , MT can reduce psychological and physical distress and can have a positive effect on quality of life Studied children with mild to moderate juvenile rheumatoid arthritis who were massaged by their parents 15 minutes a day for 30 days ( and a control group engaged in relaxation therapy ) . The children 's anxiety and stress hormone ( cortisol ) levels were immediately decreased by the massage , and over the 30-day period their pain decreased on self-reports , parent reports , and their physician 's assessment of pain ( both the incidence and severity ) and pain-limiting activities AIM The present study has examined whether interactive music may be considered an effective treatment for the attenuation of anxiety in oncological paediatric patients undergoing painful procedures ( lumbar injection , bone marrow aspiration , osteomedullary biopsy and arterial catheter ) . METHODS Thirty-nine tumour patients aged between 2 and 12 were r and omised into 2 groups : Music ( M ) ( N. 20 ) and Controls ( N. 19 ) and were treated by M : conscious sedation and intervention of interactive music and C : sedation . The following factors were assessed : temperament on the Emotivity , Activity , Sociability scale , anxiety on the Yale preoperative anxiety scale ( mYPAS ) , the induction compliance checklist ( ICC ) , parent anxiety by cataloguing the trait-state anxiety inventory , and the degree of satisfaction of children , parents and staff using the Barrera question naires . Data significance was accepted with values of P<0.05 . RESULTS There was a fall in mYPAS values in M compared to C in the four phases of the process : Phase 1 ( P<0.05 ) ; Phase 2 , 3 and 4 ( P<0.01 ) . For the ICC children with a score of < or=1 , ' ' collaborated ' ' , those with a score of > 1 were ' ' non collaborators ' ' ; in the music group the trend was for an increase in the number of collaborating children ( P<0.07 ) . CONCLUSIONS The M group presents a significant effect of attenuation of anticipatory anxiety and a tendency to great induction compliance compared to group C. The parents do not show any significant anxiety attenuation effect . The degree of satisfaction of children , parents and staff point to a positive role and a beneficial effect of interactive music on the occasion of painful procedures BACKGROUND Children with leukemia undergo painful procedures such as  lumbar puncture and bone marrow aspiration .  To overcome pain , certain units offer total anesthesia ; others offer generic support ; others offer no preparation at all . Since September , 1997 , we have provided leukemic children  with art therapy ( AT ) , a nonverbal and creative modality that develops coping skills . Our goal is to prevent anxiety and fear during painful interventions as well as prolonged emotional distress . PROCEDURE We treated 32 children aged 2 - 14 years . The modes of AT before , during , and after the punctures were as follows : clinical dialogue to calm children and help them cope with painful procedures ; visual imagination to activate alternative thought processes and decrease the attention towards overwhelming reality and raise the peripheral sensitivity gate ; medical play to clarify illness , eliminate doubts , and offer control over threatening reality ; structured drawing to contain anxiety by offering a structured , predictable reality ( the drawing ) that was controllable by children ; free drawing to allow children to externalize confusion and fears ; and dramatization to help children accept and reconcile themselves to body changes . RESULTS Children hospitalized before September , 1997 , exhibited resistance and anxiety during and after painful procedures . By contrast , children provided with AT from the first hospitalization exhibited collaborative behavior . They or their parents asked for AT when the intervention had to be repeated . Parents declared themselves better able to manage the painful procedures when AT was offered . CONCLUSION AT was shown to be a useful intervention that can prevent permanent trauma and support children and parents during intrusive interventions Hypnosis was compared with nonhypnotic behavioral techniques for efficacy in reducing pain and anxiety in 27 children and adolescents during bone marrow aspiration and in 22 children and adolescents during lumbar puncture . The patients and independent observers each rated ( scale of 1 to 5 ) pain and anxiety during one to three procedures prior to intervention and one to three procedures with intervention . Prior to intervention for both groups , pain during bone marrow aspiration was rated as more severe ( P less than 0.01 ) than pain during lumbar puncture . During bone marrow aspiration pain was reduced to a large extent by hypnosis ( P less than 0.001 ) and to a smaller but significant extent by nonhypnotic techniques ( P less than 0.01 ) , and anxiety was significantly reduced by hypnosis alone ( P less than 0.001 ) . During lumbar puncture only hypnosis significantly reduced pain ( P less than 0.001 ) ; anxiety was reduced to a large degree by hypnosis ( P less than 0.001 ) and to a smaller degree by nonhypnotic techniques ( P less than 0.05 ) . Thus hypnosis was shown to be more effective than nonhypnotic techniques for reducing procedural distress in children and adolescents with cancer In this article the positive effects of massage therapy on biochemistry are review ed including decreased levels of cortisol and increased levels of serotonin and dopamine . The research review ed includes studies on depression ( including sex abuse and eating disorder studies ) , pain syndrome studies , research on auto-immune conditions ( including asthma and chronic fatigue ) , immune studies ( including HIV and breast cancer ) , and studies on the reduction of stress on the job , the stress of aging , and pregnancy stress . In studies in which cortisol was assayed either in saliva or in urine , significant decreases were noted in cortisol levels ( averaging decreases 31 % ) . In studies in which the activating neurotransmitters ( serotonin and dopamine ) were assayed in urine , an average increase of 28 % was noted for serotonin and an average increase of 31 % was noted for dopamine . These studies combined suggest the stress-alleviating effects ( decreased cortisol ) and the activating effects ( increased serotonin and dopamine ) of massage therapy on a variety of medical conditions and stressful experiences PURPOSE To test the effectiveness of supplementing usual supportive care with aromatherapy massage in the management of  anxiety and depression in cancer patients through a pragmatic two-arm r and omized controlled trial in four United Kingdom cancer centers and a hospice . PATIENTS AND METHODS Two hundred eighty-eight cancer patients , referred to complementary therapy services with clinical anxiety and /or depression , were allocated r and omly to a course of aromatherapy massage or usual supportive care alone . RESULTS Patients who received aromatherapy massage had no significant improvement in clinical anxiety and /or depression compared with those receiving usual care at 10 weeks postr and omization ( odds ratio [ OR ] , 1.3 ; 95 % CI , 0.9 to 1.7 ; P = .1 ) , but did at 6 weeks postr and omization ( OR , 1.4 ; 95 % CI , 1.1 to 1.9 ; P = .01 ) . Patients receiving aromatherapy massage also described greater improvement in self-reported anxiety at both 6 and 10 weeks postr and omization ( OR , 3.4 ; 95 % CI , 0.2 to 6.7 ; P = .04 and OR , 3.4 ; 95 % CI , 0.2 to 6.6 ; P = .04 ) , respectively . CONCLUSION Aromatherapy massage does not appear to confer benefit on cancer patients '  anxiety and /or depression  in the long-term , but is associated with clinical ly important benefit up to 2 weeks after the intervention This prospect i ve controlled trial investigated the efficacy of a manual-based clinical hypnosis intervention in alleviating pain in 80 pediatric cancer patients ( 6–16 years of age ) undergoing regular lumbar punctures . Patients were r and omly assigned to 1 of 4 groups : direct hypnosis with st and ard medical treatment , indirect hypnosis with st and ard medical treatment , attention control with st and ard medical treatment , and st and ard medical treatment alone . Patients in the hypnosis groups reported less pain and anxiety and were rated as demonstrating less behavioral distress than those in the control groups . Direct and indirect suggestions were equally effective , and the level of hypnotizability was significantly associated with treatment benefit in the hypnosis groups . Therapeutic benefit de grade d when patients were switched to self-hypnosis . The study indicates that hypnosis is effective in preparing pediatric oncology patients for lumbar puncture , but the presence of the therapist may be critical Massage is increasingly applied to relieve symptoms in patients with cancer . This practice is supported by evidence from small r and omized trials . No study has examined massage therapy outcome in a large group of patients . At Memorial Sloan-Kettering Cancer Center , patients report symptom severity pre- and post-massage therapy using 0 - 10 rating scales of pain , fatigue , stress/anxiety , nausea , depression and " other . " Changes in symptom scores and the modifying effects of patient status ( in- or outpatient ) and type of massage were analyzed . Over a three-year period , 1,290 patients were treated .  Symptom scores were reduced by approximately 50 % , even for patients reporting high baseline scores . Out patients improved about 10 % more than in patients . Benefits persisted , with out patients experiencing no return toward baseline scores throughout the duration of 48-hour follow-up . These data indicate that massage therapy is associated with substantive improvement in cancer patients ' symptom scores CONTEXT Aromatherapy is frequently recommended for children but children 's preferences for specific essential oils are not well documented . OBJECTIVE To measure preferences of school aged children for essential oils based on gender and ethnicity . DESIGN Descriptive study measuring children 's responses to and preferences for selected essential oils . SETTING Pediatric integrative medicine clinic in a Midwestern children 's hospital . PARTICIPANTS Healthy school-age children of Latino ( N = 39 ) and non-Latino Caucasian ( NLC ) ( N = 48 ) ethnicity , 41.7 % of the NLC group and 59.0 % of the Latino Group were males . INTERVENTION Participants smelled single essential oils , answered three forced choice questions and one open ended question , order of exposure was varied . OUTCOME MEASURES Participants evaluated each scent 's effect on mood and energy , stated their preferences , indicated if scents evoked particular thoughts and selected a favorite essential oil . RESULTS Females were more likely to feel happy when smelling sweet orange ( p = .043 ) . Female Latinos were more likely than NLC females to find sweet orange calming ( 56.2 % vs. 18.5 % ) . Male Latinos were more likely ( 65.2 % ) to describe peppermint as " energetic " than male NLC ( 30 % ) . Children chose an essential oil that they rated as " making them feel happy " ( 72.6 % ) and /or as " liking the most " ( 64.3 % ) . Other results that approached statistical significance were : females felt more energetic with spearmint ( p = .055 ) . Latinos preferred spearmint over NLC ( p = .075 ) , and all males felt more energetic when smelling ginger ( p = .091 ) . Ginger and lavender were the least preferred . Results indicate that children have specific essential oil scent preferences . There is trend toward differences based on gender and ethnicity BACKGROUND The use of music therapy with children in health setting s has been documented , but its effectiveness has not yet been well established . This pilot study is a preliminary exploration of the effectiveness of interactive music therapy in reducing anxiety and increasing the comfort of hospitalized children with cancer . METHODS Pre- and post-music therapy measures were obtained from children ( N = 65 ) and parents . The measures consisted of children 's ratings of mood using schematic faces , parental ratings of the child 's play performance , and satisfaction question naires completed by parents , children and staff . RESULTS There was a significant improvement in children 's ratings of their feelings from pre- to post-music therapy . Parents perceived an improved play performance after music therapy in pre-schoolers and adolescents but not in school-aged children . Qualitative analyses of children 's and parents ' comments suggested a positive impact of music therapy on the child 's well-being . CONCLUSIONS These preliminary findings are encouraging and suggest beneficial effects of interactive music therapy with hospitalized pediatric hematology/oncology patients . In future studies replicating these findings should be conducted in a r and omized control trial This mixed methods pilot study evaluated the effects of the creative arts therapy ( CAT ) on the quality of life ( QOL ) of children receiving chemotherapy .  A 2-group , repeated measures r and omized design compared CAT with a volunteer ’s attention ( n = 16 ) . Statistical analysis of the r and omized controlled phase of the study suggested an improvement in the following areas after the CAT : parent report of child ’s hurt ( P = .03 ) and parent report of child ’s nausea ( P = .0061 ) . A nonr and omized phase , using a different instrument showed improved mood with statistical significance on the Faces Scale ( P < .01 ) , and patients were more excited ( P < .05 ) , happier ( P < .02 ) , and less nervous ( P < .02 ) . Provider focus groups revealed positive experiences . Case studies are included to exemplify the therapeutic process . With heightened interest in complementary therapy for children with cancer , future research with a larger sample size is needed to document the impact of incorporating creative arts into the healing process BACKGROUND We investigated whether acupuncture as a supportive antiemetic approach reduces the need for antiemetic rescue medication during highly emetogenic chemotherapy in pediatric oncology . We report on a multicenter crossover study at 5 tertiary hospitals in Germany . PROCEDURE Twenty-three children ( 13.6 y,+/- 2.9 ) receiving highly emetogenic chemotherapy for treatment of solid malignant tumors were included . Patients were r and omly allocated to receive acupuncture treatment during either the second or third identical chemotherapy course together with st and ard antiemetic medication . The main outcome measure was the amount of additional antiemetic medication during chemotherapy . Secondary outcome measure was the number of episodes of vomiting per course . RESULTS Fourty-six chemotherapy courses with or without acupuncture were compared . The need for rescue antiemetic medication was significantly lower in acupuncture courses compared to control courses ( p=0.001 ) Episodes of vomiting per course were also significantly lower in courses with acupuncture ( p=0.01 ) . Except for pain from needling ( 4/23 ) no side effects occurred . Patients acceptance of acupuncture was high . CONCLUSIONS Acupuncture as applied here seems to be effective in preventing nausea and vomiting in pediatric cancer patients OBJECTIVE Though often lifesaving , stem cell transplantation ( SCT ) is a period of great distress for both child and parent . METHODS We conducted a double-blind , placebo-controlled r and omized study evaluating the effect of the respiratory administration of bergamot essential oil on the anxiety , nausea , and pain of 37 pediatric patients with malignant and non-malignant disorders undergoing stem cell infusion and their parents . Patients were assessed at the time of recruitment , prior to infusion , upon infusion completion , and one hour post-infusion using the Spielberger State-Trait Anxiety Inventory ( STAI ) for parents and the STAIC , Children 's Behavioral Style Scale ( CBSS ) , visual analogue scale ( VAS ) for pain and nausea , and the Emotionality Activity Sociability and Impulsivity instrument ( EASI ) for children . RESULTS Children and adolescents in the treatment group experienced greater anxiety ( p = 0.05 ) and nausea ( p = 0.03 ) one hour post-infusion . Reported pain in both groups was no longer significant one hour post-infusion . Parental anxiety declined in both groups but did not reach statistical significance . Child 's monitoring coping style was significantly predictive of transitory anxiety post-infusion ( p = 0.01 ) . CONCLUSIONS Although this trial did not report a benefit of inhalation aromatherapy for reducing anxiety , nausea , or pain when added to st and ard supportive care , it provides the first experimental rather than descriptive report on testing a single therapeutic essential oil among children and adolescents undergoing stem cell infusion . Future research may consider exploring the cutaneous application of essential oil through massage or other psychoeducational counseling interventions among parents with elevated anxiety and patients with greater information seeking coping styles during SCT Thirty-two children with asthma ( 16 4- to 8-year-olds and 16 9- to 14-year-olds ) were r and omly assigned to receive either massage therapy or relaxation therapy . The children 's parents were taught to provide one therapy or the other for 20 minutes before bedtime each night for 30 days . The younger children who received massage therapy showed an immediate decrease in behavioral anxiety and cortisol levels after massage . Also , their attitude toward asthma and their peak air flow and other pulmonary functions improved over the course of the study . The older children who received massage therapy reported lower anxiety after the massage . Their attitude toward asthma also improved over the study , but only one measure of pulmonary function ( forced expiratory flow 25 % to 75 % ) improved . The reason for the smaller therapeutic benefit in the older children is unknown ; however , it appears that daily massage improves airway caliber and control of asthma PURPOSE To determine whether the inhalation of aromatherapy during radiotherapy reduces anxiety . PATIENTS AND METHODS Three hundred thirteen patients undergoing radiotherapy were r and omly assigned to receive either carrier oil with fractionated oils , carrier oil only , or pure essential oils of lavender , bergamot , and cedarwood administered by inhalation concurrently with radiation treatment . Patients underwent assessment by the Hospital Anxiety and Depression Scale ( HADS ) and the Somatic and Psychological Health Report ( SPHERE ) at baseline and at treatment completion . RESULTS There were no significant differences in HADS depression or SPHERE scores between the r and omly assigned groups . However , HADS anxiety scores were significantly lower at treatment completion in the carrier oil only group compared with either of the fragrant arms ( P = .04 ) . CONCLUSION Aromatherapy , as administered in this study , is not beneficial The existing review s of massage therapy ( MT ) research are either limited to infants , adults , or were conducted prior to the publication of the most recent studies using pediatric sample s. R and omized controlled trials ( RCTs ) of pediatric MT are review ed . A literature search yielded 24 RCTs of pediatric MT  , defined as the manual manipulation of soft tissue intended to promote health and well-being in recipients between 2 and 19 years of age . Because RCTs of pediatric MT varied considerably in the amount and types of data reported , quantitative and narrative review methods were both used . Single-dose and multiple-dose effects were examined separately . Among single-dose effects , significant reductions of state anxiety were observed at the first session ( g = 0.59 , P < 0.05 ) and the last session ( g = 1.10 , P < 0.01 ) of a course of treatment . Effects for salivary cortisol ( g = 0.28 ) , negative mood ( g = 0.52 ) and behavior ( g = 0.37 ) were non-significant . Three of eleven multiple-dose effects were statistically significant . These were trait anxiety ( g = 0.94 , P < 0.05 ) , muscle tone ( g = 0.90 , P < 0.01 ) and arthritis pain ( g = 1.33 , P < 0.01 ) . Results of studies not permitting effect size calculation were judged to be generally consistent with quantitative results . MT benefits pediatric recipients , though not as universally as sometimes reported . Numerous weaknesses endemic to MT research ( e.g. low statistical power , frequent failure to report basic descriptive statistics ) are identified , and recommendations for future pediatric MT research are discussed
BACKGROUND The effects of cancer and associated treatments have a considerable impact on the well-being and quality of life of pediatric oncology patients .
To support children and their families , complementary and alternative medicines are seen by nurses and doctors as practical to integrate to the services offered by hospitals .
OBJECTIVE The purpose of this paper is to examine if the practice of complementary and alternative medicine , specifically spiritual care and treatments based on body manipulation , is likely to improve the health and well-being of children suffering from cancer .