Connecting the Mind and Body through Evidence-Based Integrative Modalities

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Dr. Daniel Simon (host): Hello, everyone. My name is Dr. Daniel Simon. I am your host of the Science@UH podcast, sponsored by the University Hospitals Research and Education Institute. This podcast series features University Hospitals’ cutting edge research and innovations. Thank you for listening to another episode. Today, I am happy to be joined by two guests from the UH Connor Whole Health Institute.

Dr. Francoise Adan, and Sam Rodgers-Melnick. Dr. Adan is the Chief Whole Health and Well Being Officer, as well as the founder and director of Connor Whole Health, UH's premier integrative health initiative. Sam is a music therapist and clinical researcher who focuses on investigating the effectiveness of integrative therapies.

Both Francoise’s and Sam's research I've been on using large electronic health record databases to study the impact of integrative modalities on pain. Welcome Francoise and Sam.

Sam Rodgers-Melnick: Thanks for having us.

Dr. Francoise Adan: Happy to be here.

Dr. Daniel Simon: Well, it's terrific to have both of you here today and we love it when there's the back and forth of three people. So, Connor Whole Health is a leading innovator in delivering evidence based integrative modalities including acupuncture, chiropractic, expressive therapies, and massage in collaboration with providers throughout the UH health system.

Francoise, can you tell us more about the strategy behind Connor Whole Health and the impact it has had in our community? What is the concept that drives Connor Whole Health?

Dr. Francoise Adan: We are really lucky at University Hospital to have a system that is really supportive of innovation and in particular of Institute the Connor Whole Health. What Connor Whole Health offers is, a commitment to serve, to serve our community, to serve our patients, and of course, to serve our colleagues. What does that even mean? It means that our entire role is really based on enhancing the care that we already provide at UH, and adding evidence based modalities to increase the clinical outcome and hopefully also looking at ways that we do more than that. We increase patient expense, provider expense, and looking at model of care that can reduce cost.

Dr. Daniel Simon: Well, let me ask you this. I know that your own career as a trained in psychiatry and board certified in holistic and integrative medicine, that your areas of interest have been stress management, work life balance, and mind body spirit connection. How does Whole Health really address those?

Dr. Francoise Adan: Whole health, really, what does it mean? It means good medicine. That's really what that is. And understanding that there is a, of course, a connection between the mind and body and the body and the mind, and that we really need to address the whole person care. We cannot only focus on organ focus or disease focus. We need to look at the full gamut of the health journey.

And maybe adding a little bit of personalization in the care that our patients receive. So, a simple question like this, what matters to you when a patient come in? Instead of only focus on what is wrong with you? What is the matter with you? That entire shift opened the door to really understand the patient needs, goals, priorities, and making sure that our treatment plan that we coordinate with the entire treatment team is addressing those.

Dr. Daniel Simon: That's really terrific. So the use integrative approaches to health and wellness has grown significantly across the U. S., and the experts at UH Connor Whole Health work on many research projects to further investigate the healthfulness of integrative therapies in a variety of symptoms and conditions. Maybe we can tag team here, start with you, Sam. Tell us a little bit about some of the research projects that you're working on in Connor Whole Health.

Sam Rodgers-Melnick: Yeah, so Connor has this massive research portfolio that kind of spans that translational science continuum from basic science expressive therapies, looking at gene expression mechanisms by which music therapy affects post-surgical pain, all the way to how can we best implement these modalities throughout the health system.

My focus has particularly been on leveraging our University Hospital's electronic health record to conduct some of the largest studies ever conducted on the real world impact of acupuncture, massage, chiropractic, and expressive therapies throughout the health system.

Dr. Daniel Simon: So, you know, it's very interesting. I've seen some of your data, which just, blows me away and maybe we could walk our listeners through, you know, when we think about someone in the hospital who's had a recent, for instance, surgical procedure, they have pain, they have stress, they have anxiety and what's remarkable to me is the power of music therapy on very quantitative scales. Maybe you could just take us through and, explain, just how good it is at reducing pain and stress.

Sam Rodgers-Melnick: So pain, stress, and anxiety are difficult because they're so profound. They're so severe. They affect so many outcomes, not in terms of the patient experience, but cost and length of stay, but they're also subjective. We don't have any, purely objective pain-o-meter you could put on a patient to objectively measure their pain. We rely on these zero to ten measures. But when you're in the hospital, we've relied for a long time on pharmacologic approaches, which have put us in a poor position, sometimes not only in patient care, but in terms of risk of opioid dependence and things like that.

As music therapists, we get consults from the medical team, we introduce ourselves to the patients, we perform an assessment of how are you managing your hospitalization? What's stressing you out, what helps you cope with those things, what music could best address your situation? We also assess how you're feeling, pain, stress, anxiety, coping before the session. We then provide a personalized music intervention, whether that's listening to relaxing music with imagery or actively engaging in a music intervention or writing music. The way that we engage the patient in that process becomes what is important about music therapy. And we evaluate that and we've seen reductions of over two units on a 0 to 10 scale, which is clinically meaningful and sometimes even more than what your typical opioid dose would provide. Even greater reductions in stress and greater reductions in anxiety, almost 3.5 unit reductions in anxiety* across patients who have moderate to severe symptoms within our community hospitals.

*Post recording correction: 3.5 unit reduction in stress

Dr. Daniel Simon: You know, that's just incredible because I think that, you know, when we think about Dilaudid, fentanyl, Ativan, and you realize that you're getting more bang for the buck, with, music therapy. It’s incredibly impressive and I think really calls to mind the importance of why we've added, Connor Whole Health to our repertoire.

So Francoise, maybe I could turn to you. You know, we think about a lot of times about chronic pain, but, we also, have very cool research that you're doing in acute pain, acupuncture in the emergency room. Maybe you could tell us a little bit about the research studies that you've been doing related to patients presenting to the emergency room with acute pain and the effects of acupuncture.

Dr. Francoise Adan: So that was a NIH granted study where we really study the opportunities to have an acupuncturist placed in an emergency room and addressing the patient arriving with pain, any kind of pain except traumatic event. And we really saw some very robust data showing again, the efficacy not only in managing pain and anxiety, but also reducing on prescriptions.

So, I think that our signature then is at, Connor Whole Health and at University Hospitals is to really study those modalities into real life. We know they work. There are thousands and thousands of already published articles on proving the efficacy of acupuncture, but what is it like in the real world, right? Putting an acupuncturist in an emergency room? It’s required, a lot of education from the treatment team. It's making sure that the acupuncturist is never in the way of the care that is providing. It's education also in partnership with the patients. It's just go way beyond the fact that is it working? How is it going to work? And how do we make it work in real life? And so I think that's really our signature at UH and certainly Sam has been instrumental with that.

Dr. Daniel Simon: That's terrific. So Sam, a major focus of your research throughout your career has been investigating the impact of music therapy on chronic pain among individuals with sickle cell disease. What have you discovered during that time and how is your research continuing to grow now?

Sam Rodgers-Melnick: Yeah, so my journey with that population really began when I came here to University Hospitals in 2012 as a music therapy intern. One of my supervisors had this idea for a project to bring group drumming to the Medical Oncology Unit to help manage pain and provide social support. And we noticed that patients, even in the midst of an acute severe pain crisis, that basal occlusion of sickle cell disease, came to the sessions. As they engaged in drumming and singing and rapping with each other, that was helpful for reducing their pain. It also provided a way of supporting each other.

And I saw that there were a lot of health challenges within this population that now are not being adequately addressed, including severe and very complex chronic pain, distrust between patients and providers, the poor transition between pediatric and adult care. And I thought that music therapy could address those challenges, but at the time there was no music therapy research. So in 2014, we received our first Kulas Foundation grant to investigate our BEATS program, which stands for Build, Educate, Advance, Transition in sickle cell disease. It was a songwriting program where patients made beats and songs to understand their hemoglobin and managing medications. We saw improvements in sickle cell knowledge from that.

We did a three arm randomized control trial comparing music therapy to listening to a playlist to no music, and we saw that you were much more likely to have a clinically meaningful improvement in your pain intensity and mood if you were a music therapist. But in chronic pain, it's not just the pain intensity that you feel, you're 0 to 10 now, but you're 0 to 10 later. It's what is your relationship to pain and how does it affect you day to day? So to look at that, we got another grant from the Kulas Foundation in 2017 to look at how people with sickle cell disease use music.

And we found that the more strategies they use along with music, whether it's singing, doing deep breathing exercises, that's more helpful for pain. We then did another randomized control trial where we gave people practical music exercises that they can do. Breathing with music, imagery with music, actively engaging in improvising music. And we gave them those tools and we saw improvements in self efficacy, your confidence in your ability to manage your disease, reductions in pain interference, reductions in sleep disturbance, and we showed initial feasibility. And what I'm excited to announce now is we've built on that.

We recently received a grant from the National Center for Complementary and Integrative Health, part of the NIH, to look at the multi-site feasibility of these interventions at UH and in South Carolina in partnership with Piedmont Music Therapy and PRISMA. We also got another NIH grant to look at the mechanisms, what is happening, the mechanisms by which music therapy affects pain with a specific focus on people with sickle cell disease.

Dr. Daniel Simon: Well, that's really great. You know, University Hospitals follows nearly 300 patients with sickle cell disease and it's a huge burden. It shortens your overall survival significantly and really impairs, quality of life. So I'm so glad that you're leading those studies. I guess, Sam, we want to congratulate you, Francoise, and I want to congratulate you on your recent two year F31 fellowship award from the National Center for Complementary and Integrative Health, the division of the National Institutes of Health, and this is obviously, terrific. Tell us, what are you going to do with this great new award from NIH?

Sam Rodgers-Melnick: So this builds on really the legacy of music therapy at University Hospitals. Our program started in the 1980s by Dr. Deforia Lane, and then expanded upon by Seneca Block, who's now the endowed director of expressive therapies. We have over 10 music therapists in 10 hospitals throughout the UH system. And a few years ago, I developed a way to best document the impact we're having in the electronic health record, just as a way to make data capture easier.

Well, that became the largest observational data set ever. And so we recently completed these four EMPIRE studies, Effectiveness of Medical Music Therapy Practice, using the Electronic Health Record. And we demonstrated that music therapy could be integrated throughout the health system. These clinically meaningful impacts on pain, stress, and anxiety in community hospitals and in hematology, oncology. We then did the quality improvement initiative to increase our data capture among the music therapy team. And with that, that became the opportunity for what we can do in my proposal, which is called DRUMR. I am a drummer and DRUMR stands for Developing Real World Understanding of Medical Music Therapy Using Electronic Health Record. And what I want to do is look beyond that single session. Yes, one session will reduce your pain, stress, and anxiety, but beyond that. What predicts that? Are there factors related to the patient or the diagnosis or the decisions that music therapists make? Whether the patient is improvising or receiving imagery that make a difference in that change in score.

I want to compare people who receive music therapy to matched controls using propensity score matching who do not receive music therapy to look at some pretty important outcomes like length of stay, opioid and anxiety medication utilization, and pain intensity captured over the course of the hospitalization, and then look at not just the single session impact, but the impact on pain, stress, and anxiety across the hospitalization. So it's really expanding the scope of observational studies and medical music therapy, which can also translate to all of our integrative health and medicine modalities delivered throughout UH.  

Dr. Daniel Simon: Wow, that's really cool. I'm so glad, and congratulations on that award. So, Francoise, we want you to, sort of wrap this up, and give you a chance to, tell us about what's really exciting and new at Connor Whole Health. It could be anything. I obviously am incredibly impressed by your acupuncture and fertility program because I think it's so unusual. So maybe tell us a little bit about that and, then anything else that you think is really cool right now.

Dr. Francoise Adan: There's never boring day at the UH Connor Whole Health. I can tell you that. There's always something cooking and some dream that we are pursuing. So our program with fertility is actually exploding. We are now really working with, again, our fertility colleagues, developing a specific intervention to support mothers and their significant daughters to go to the journey of fertility and reproductive health, all the way from group support, but also education about nutrition and movement and sleep and just focusing on a lifestyle modification. And, that is one intervention.

And, of course, we have a rock star, Christine Kaiser, acupuncturist who is leading and, we are actually doing research on this. Seeing the benefits of acupuncture on women, pursuing the goal of getting pregnant. And we have some very, very exciting data that we'll be able to share soon.

Dr. Daniel Simon: Wow. Well, that sounds, really so cool. I think that, we're lucky to have both of you. I remember, Francoise and I have started down the path of Connor Whole Health over a decade ago now and to see it grow is just absolutely, amazing and we're so proud of you.

I want to thank you for taking the time to speak with us today, Francoise and Sam and want to remind our audience to learn more about research at University Hospitals.

Please visit uhhospitals.org/UHResearch. Thank you very much.