Beyond Medicine: Easing Stress and Pain

It started, as most good ideas do, from a desire to help relieve the suffering of children. In this case, Tracey Jubelirer, MD, an oncologist at Children’s Hospital of Philadelphia (CHOP), was searching for ways to relieve the anxiety, pain and nausea she saw her cancer patients going through during their treatment.

Yoga instructor Tonia Kulp helps Cameron, 7, de-stress before chemotherapy sessions. “How can we provide nonpharmacological support to help them through their treatment journey?” she says. “That was my starting point.”

She had reviewed studies of how integrative therapies — like yoga, acupuncture, aroma therapy and massage — had helped adult patients, but there was little research specifically on pediatric patients. In partnership with CHOP’s Integrative Medicine Program and with the support of generous donors, Jubelirer pushed to make these complementary therapies available in CHOP’s Specialty Care Centers in King of Prussia, Pa., and Voorhees, N.J., in addition to inpatients in the hospital in University City.

“Parents tell me they really appreciate it and feel like it is helping their children,” Jubelirer says. Cameron, a 7-year-old with Ewing sarcoma, would get so stressed out before his chemotherapy that it was making him physically sick.

“Cameron had so much anxiety when he came for treatment,” Jubelirer says. “Tonia Kulp, our yoga instructor, worked with him and taught him how to use his own mind and breath to calm down and reduce the stress. It made a big difference. His nausea was gone.”

The key to success is “meeting patients where they are,” Jubelirer says.

For some children with cancer, a gentle massage can make a world of difference. Massage therapist Tiffany Silliman Cohen, LMT, PHMII, CIMT, coordinates with oncologists and physical therapists in the Voorhees oncology clinic to determine which patients may benefit from massage therapy.

“I’ll ask the child if they’re in pain, having discomfort or are stressed out,” Cohen says. “Then, I adapt the massage to serve their needs on that particular day.”

Sometimes, she’ll give a massage while patients are waiting to see their oncologist or for their chemotherapy to begin. She can even massage a child’s back during treatment. “They lean forward so I can work on their back,” she says. “I also will massage an arm. We make it work.”

Massage for children is much gentler than what an adult may have. Children remain clothed, and one parent is always present. If Cohen notices a type of massage is particularly effective, she’ll teach the child’s parent the technique so the therapy can also happen at home.

“We see the benefits both physically and psychologically,” Cohen says. “Massage can reduce stress-related symptoms so the child is more relaxed. It can help reduce pain. It can even help with headache.”

Even the option to have a massage or not can be empowering. “These children are facing interventions that are painful and scary, and they’re not there by choice,” Cohen says. “Having a choice to have a massage, even if they turn it down that day, restores a bit of control, and I think that has value.”