Greetings from Tennessee, the volunteer state! I am Charlene Gayle Story Pattillo, and I am honored to serve as the coordinator-elect for the PNI and Complementary Therapies SIG. Charlene S. Pattillo is my legal and professional name, but my friends call me Gayle, and I hope you will too!

My interest in PNI began in 1994 when I attended the Journal of Nursing Jocularity's Humor Skills for the Health Professional Conference at Disneyland in Anaheim, CA. I've always used my sense of humor as a coping technique, but until that conference I had no idea scientific studies had been done to support humor as an intervention. Since then, I've had a passion for developing and using humor as therapy. Humor and joy are not one-dimensional, and my journey has led me to interests in faith, music, art, journaling, environment, language, and other uncommonly used therapies in the healthcare arena. Many complementary therapies are becoming more widely accepted as treatment modalities (e.g., massage, imagery, relaxation, aromatherapy). My own state of Tennessee is exploring legislation to allow third-party payment for integrative treatments. I am very interested in learning more about various treatment options and means of enhancing quality of life for patients, caregivers, and ourselves. I would like to increase networking opportunities among members with similar interests and needs by knowing the work members are involved in and sharing resources, especially evidence-based practices that validate treatment.

I am exploring the possibility of the Therapeutic Humor Focus group joining with our SIG. The work of our SIG leaders has been tremendous, and I hope to build on our strong foundation. The rejuvenation sessions at Congress educated and served those attending. I hope we will continue to develop the elevator speeches, which are a wonderful teaching and learning tool to have ready to share at a moment's notice when someone asks what you do for a living. I also am interested in continuing Coordinator Gwen Wyatt's, RN, PhD, hopes of using telephone conferences and e-mail to explore Congress submissions and other ideas, such as publications. I've grown tremendously through opportunities at ONS, such as having a mentor to help with publishing an article and responding to Jo Ann C. Owen's, BSN, RN, call to SIG members a couple of years ago to present at Congress. CDR Colleen Lee, RN, MS, AOCN^®, led me through the process. I would like to continue to grow and encourage others as well. "Two are better than one, because they have a good return for their work: If one falls down, his friend can help him up . . . Though one may be overpowered, two can defend themselves. A cord of three strands is not quickly broken"—Ecclesiastes 4:9–12 (The New International Version). I hope we will work together to help our SIG strengthen and grow as a visible force within ONS.

My interest in reflexology, a complementary therapy, developed during my doctoral studies at the University of South Carolina at Columbia when one of my committee members, Dan Pesut, PhD, RN, FAAN, suggested an article on the topic. After 100 hours of classroom study, 100 hours of practice, and successful completion of a written and practicum examination, I became certified by the International Institute of Reflexology in St. Petersburg, FL. Becoming certified in reflexology took about a year. Since then, my interest in reflexology has expanded to research. For my dissertation under the direction of Sally Weinrich, PhD, RN, FAAN, I used a crossover design to compare reflexology with usual care in 23 inpatients with cancer. In 2001, I studied 36 patients with cancer as part of my postdoctoral studies at the University of North Carolina at Chapel Hill under the direction of Dr. Jo Ann Dalton, EdD, RN, FAAN. This study found a significant decrease in pain and anxiety immediately following the intervention. I was able to establish a reflexology dosage time of 30 minutes. Currently, I am in the second year of a National Cancer Institute-funded study titled "Partner-Delivered Reflexology: Effects on Cancer Pain." In this study, I follow patients into their homes and work with a family member, friend, or healthcare provider who partners with the patient to provide the reflexology intervention. If you would like to learn more about reflexology, please refer to the following articles.

• Stephenson, N.L., Weinrich, S.P., & Tavakoli, A.S. (2000). The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Oncology Nursing Forum, 27, 67-72.

This article discusses in detail my second pilot study, the history and definition of reflexology, and how to become certified in reflexology.

• Stephenson, N.L., & Dalton, J.A. (2003). Using reflexology for pain management. A review. Journal of Holistic Nursing, 21, 179-191.

This article explains the neuromatrix theory of pain and how the reflexology intervention works with that theory. The pathophysiology of pain is included.

• Stephenson, N., Dalton, J.A., & Carlson, J. (2003). The effect of foot reflexology on pain in patients with metastatic cancer. Applied Nursing Research, 16, 284-286.

This article presents results from my third pilot study and includes references for equianalgesic dosing.

Energy Medicine
An Overview

Note. This article is abridged from one of a series of five background reports prepared as part of the National Center for Complementary and Alternative Medicine's strategic planning efforts for 2005–2009. The purpose of these reports is to provide a sense of the research challenges and opportunities in particular CAM approaches. The full report with links to relevant sites can be found at http://nccam.nih.gov/health/backgrounds/energymed.htm.

Introduction
Energy medicine is a domain in CAM that deals with energy fields of two types (Berman & Straus, 2004): veritable, which can be measured, and putative, which have yet to be measured. The veritable energies employ mechanical vibrations (such as sound) and electromagnetic forces, including visible light, magnetism, monochromatic radiation (such as laser beams), and rays from other parts of the electromagnetic spectrum. They involve the use of specific, measurable wavelengths and frequencies to treat patients (Vallbona & Richards, 1999). In contrast, putative energy fields (also called biofields) have defied measurement to date by reproducible methods. Therapies involving putative energy fields are based on the concept that human beings are infused with a subtle form of energy. This vital energy or life force is known under different names in different cultures, such as "qi" in traditional Chinese medicine (TCM), "ki" in the Japanese Kampo system, "doshas" in Ayurvedic medicine, and elsewhere as "prana," "etheric energy," "fohat," "orgone," "odic force," "mana," and "homeopathic resonance" (Hintz et al., 2003). Vital energy is believed to flow throughout the material human body, but it has not been unequivocally measured by means of conventional instrumentation. Nonetheless, therapists claim that they can work with this subtle energy, see it with their own eyes, and use it to effect changes in the physical body and influence health.

Practitioners of energy medicine believe that illness results from disturbances of these subtle energies (the biofield). For example, more than 2,000 years ago, Asian practitioners postulated that the flow and balance of life energies are necessary for maintaining health and described tools to restore them. Herbal medicine, acupuncture, acupressure, moxibustion, and cupping, for example, are all believed to act by correcting imbalances in the internal biofield, such as by restoring the flow of qi through meridians to reinstate health. Some therapists are believed to emit or transmit the vital energy (external qi) to a recipient to restore health (Chen & Turner, 2004). Examples of practices involving putative energy fields include: Reiki and Johrei, both of Japanese origin; Qi gong, a Chinese practice; Healing touch, in which the therapist is purported to identify imbalances and correct a client's energy by passing his or her hands over the patient; Prayer specifically for health purposes-such as intercessory prayer, in which a person intercedes through prayer on behalf of another.

In the aggregate, these approaches are among the most controversial of CAM practices because neither the external energy fields nor their therapeutic effects have been demonstrated convincingly by any biophysical means. Yet, energy medicine is gaining popularity in the American marketplace and has become a subject of investigations at some academic medical centers. A recent National Center for Health Statistics survey indicated that approximately 1% of the participants had used Reiki, 0.5% had used qi gong, 4.6% had used some kind of healing ritual, and approximately 30% had had others pray for their health (Barnes et al., 2002).

Veritable Energy Medicine
There are many well-established uses for the application of measurable energy fields to diagnose or treat diseases: electromagnetic fields in magnetic resonance imaging, cardiac pacemakers, radiation therapy, ultraviolet light for psoriasis, laser keratoplasty, and more. There are many other claimed uses as well. The ability to deliver quantifiable amounts of energies across the electromagnetic spectrum is an advantage to studies of their mechanisms and clinical effects. For example, both static and pulsating electromagnetic therapies have been employed (Vallbona & Richards, 1999).

Magnetic Therapy. Static magnets have been used for centuries in efforts to relieve pain or to obtain other alleged benefits (e.g., increased energy). Numerous anecdotal reports have indicated that individuals have experienced significant, and at times dramatic, relief of pain after the application of static magnets over a painful area. Although the literature on the biological effects of magnetic fields is growing, there is a paucity of data from well-structured, clinically sound studies. However, there is growing evidence that magnetic fields can influence physiological processes. It has recently been shown that static magnetic fields affect the microvasculature of skeletal muscle (Morris & Skalak, 2003). Microvessels that are initially dilated respond to a magnetic field by constricting, and microvessels that are initially constricted respond by dilating. These results suggest that static magnetic fields may have a beneficial role in treating edema or ischemic conditions, but there is no proof that they do.

Pulsating electromagnetic therapy has been in use for the past 40 years. A well-recognized and standard use is to enhance the healing of nonunion fractures. It also has been claimed that this therapy is effective in treating osteoarthritis, migraine headaches, multiple sclerosis, and sleep disorders (Vallbona & Richards, 1999). Some animal and cell culture studies have been conducted to elucidate the basic mechanism of the pulsating electromagnetic therapy effect, such as cell proliferation and cell-surface binding for growth factors. However, detailed data on the mechanisms of action are still lacking.

Millimeter Wave Therapy. Low-power millimeter wave (MW) irradiation elicits biological effects, and clinicians in Russia and other parts of Eastern Europe have used it in past decades to treat a variety of conditions, ranging from skin diseases and wound healing to various types of cancer, gastrointestinal and cardiovascular diseases, and psychiatric illnesses (Rojavin & Ziskin, 1998). In spite of an increasing number of in vivo and in vitro studies, the nature of MW action is not well understood. It has been shown, for example, that MW irradiation can augment T-cell mediated immunity in vitro (Logani et al., 2004). However, the mechanisms by which MW irradiation enhances T-cell functions are not known. Some studies indicate that pretreating mice with naloxone may block the hypoalgesic and antipruritic effects of MW irradiation, suggesting that endogenous opioids are involved in MW therapy-induced hypoalgesia (Rojavin et al., 1998). Theoretical and experimental data show that nearly all the MW energy is absorbed in the superficial layers of skin, but it is not clear how the energy absorbed by keratinocytes, the main constituents of epidermis, is transmitted to elicit the therapeutic effect (Szabo et al., 2003). It is also unclear whether MW yields clinical effects beyond a placebo response.

Sound Energy Therapy. Sound energy therapy, sometimes referred to as vibrational or frequency therapy, includes music therapy as well as wind chime and tuning fork therapy. The presumptive basis of its effect is that specific sound frequencies resonate with specific organs of the body to heal and support the body. Music therapy has been the most studied among these interventions, with studies dating back to the 1920s, when it was reported that music affected blood pressure (Vicent & Thompson, 1929). Other studies have suggested that music can help reduce pain and anxiety. Music and imagery, alone and in combination, have been used to entrain mood states, reduce acute or chronic pain, and alter certain biochemicals, such as plasma beta-endorphin levels (Chlan, 2001). These uses of energy fields truly overlap with the domain of mind-body medicine.

Light Therapy. Light therapy is the use of natural or artificial light to treat various ailments, but unproven uses of light extend to lasers, colors, and monochromatic lights. High-intensity light therapy has been documented to be useful for seasonal affective disorder, with less evidence for its usefulness in the treatment of more general forms of depression and sleep disorders (Martiny et al., 2004). Hormonal changes have been detected after treatment. Although low-level laser therapy is claimed to be useful for relieving pain, reducing inflammation, and helping to heal wounds, strong scientific proof of these effects is still needed (Reddy, 2004).

Energy Medicine Involving Putative Energy Fields
The concept that sickness and disease arise from imbalances in the vital energy field of the body has led to many forms of therapy. In TCM, a series of approaches are taken to rectify the flow of qi, such as herbal medicine, acupuncture (and its various versions), qi gong, diet, and behavior changes.

Acupuncture. Of these approaches, acupuncture is the most prominent therapy to promote qi flow along the meridians. Acupuncture has been extensively studied and has been shown to be effective in treating some conditions, particularly certain forms of pain (Berman & Straus, 2004). However, its mechanism of action remains to be elucidated. The main threads of research on acupuncture have shown regional effects on neurotransmitter expression, but have not validated the existence of an "energy" per se.

Qi Gong. Qi gong, another energy modality that purportedly can restore health, is practiced widely in the clinics and hospitals of China. Most of the reports were published as abstracts in Chinese, which makes accessing the information difficult. But Sancier has collected more than 2,000 records in his qi gong database which indicates that qi gong has extensive health benefits on conditions ranging from blood pressure to asthma (Sancier & Holman, 2004). The reported studies, however, are largely anecdotal case series and not randomized controlled trials. Few studies have been conducted outside China and reported in peer-reviewed journals in English. There have been no large clinical trials.

Physical Properties of Putative Energy Fields. There has always been an interest in detecting and describing the physical properties of putative energy fields. Kirlian photography, aura imaging, and gas discharge visualization are approaches for which dramatic and unique differences before and after therapeutic energy attunements or treatments have been claimed (Oschman, 2000). However, it is not clear what is being detected or photographed. Early results demonstrated that gamma radiation levels markedly decreased during therapy sessions in 100 percent of subjects and at every body site tested, regardless of which therapist performed the treatment. Recently replicated studies identified statistically significant decreases in gamma rays emitted from patients during alternative healing sessions with trained practitioners.

It has been hypothesized that the body's primary gamma emitter, potassium-40 (K40), represents a "self-regulation" of energy within the body and the surrounding electromagnetic field (Benford, 2001). The body's energy adjustment may result, in part, from the increased electromagnetic fields surrounding the hands of the healers. Furthermore, an extremely sensitive magnetometer called a superconducting quantum interference device (SQUID) has been claimed to measure large frequency-pulsing biomagnetic fields emanating from the hands of Therapeutic Touch practitioners during therapy (Zimmerman, 1990). In one study, a simple magnetometer measured and quantified similar frequency-pulsing biomagnetic fields from the hands of meditators and practitioners of yoga and qi gong. These fields were 1,000 times greater than the strongest human biomagnetic field and were in the same frequency range as those being tested in medical research laboratories for use in speeding the healing process of certain biological tissues (Sisken & Walder, 1995). This range is low energy and extremely low frequency, spanning from 2 Hz to 50 Hz. However, there are considerable technical problems in such research. For example, SQUID measurement must be conducted under a special shielded environment, and the connection between electromagnetic field increases and observed healing benefits reported in the current literature is missing.

Other studies of putative energies suggested that energy fields from one person can overlap and interact with energy fields of other people. For example, when individuals touch, one person's electrocardiographic signal is registered in the other person's electroencephalogram (EEG) and elsewhere on the other person's body (Russek & Schwartz, 1996). In addition, one individual's cardiac signal can be registered in another's EEG recording when two people sit quietly opposite one another.

Additional Theories. Thus far, electromagnetic energy has been demonstrated and postulated to be the energy between bioenergy healers and patients. However, the exact nature of this energy is not clear. Among the range of ideas emerging in this field is the theory of a Russian researcher who recently hypothesized that "torsion fields" exist and that they can be propagated through space at no less than 109 times the speed of light in vacuum; that they convey information without transmitting energy; and that they are not required to obey the superposition principle (Panov et al., 1997).

There are other extraordinary claims and observations recorded in the literature. For example, one report claimed that accomplished meditators were able to imprint their intentions on electrical devices (IIED), which when placed in a room for three months, would elicit these intentions, such as changes in pH and temperature, in the room even when the IIED was removed from the room (Tiller et al., 2004). Another claim is that water will crystallize into different forms and appearances under the influence of written intentions or types of music (Emoto, 2004).

For research, questions remain about which of the above theories and approaches can be and should be addressed using existing technologies, and how.

References
Barnes, P., Powell-Griner, E., McFann, K., & Nahin, R. (2004). Complementary and alternative medicine use among adults: United States, 2002. Advance Data, 343, 1–19.

Benford, M.S. (2001). Radiogenic metabolism: An alternative cellular energy source. Medical Hypotheses, 56(1), 33–39.

Berman, J.D., & Straus, S.E. (2004). Implementing a research agenda for complementary and alternative medicine. Annual Review of Medicine, 55, 239–254.

Chen, K.W., & Turner, F.D. (2004). A case study of simultaneous recovery from multiple physical symptoms with medical qigong therapy. Journal of Alternative and Complementary Medicine, 10(1), 159–162.

Chlan, L. (2001). Music intervention. In M. Snyder & R. Lindquist (Eds.), Complementary/alternative therapies in nursing (4th ed., pp. 58–66). New York: Springer Publishing.

Emoto, M. (2004). Healing with water. Journal of Alternative and Complementary Medicine, 10(1), 19–21.

Hintz, K.J., Yount, G.L., Kadar, I., Schwartz, G., Hammerschlagg, R., & Lin, S. (2003). Bioenergy definitions and research guidelines. Alternative Therapies in Health and Medicine, 9(Suppl. 3), A13–A30.

Logani, M.K., Bhanushali, A., Anga, A., Majmundar, A., Szabo, I., & Ziskin, M.C. (2004). Combined millimeter wave and cyclophosphamide therapy of an experimental murine melanoma. Bioelectromagnetics, 25, 516–523.

Martiny, K., Simonsen, C., Lunde, M., Clemmensen, L., & Bech, P. (2004). Decreasing TSH levels in patients with seasonal affective disorder (SAD) responding to 1 week of bright light therapy. Journal of Affective Disorders, 79(1–3), 253–257.

Morris, C.E., & Skalak, T.C. (2003, April). Effects of static magnetic fields on microvascular tone in vivo. Abstract presented at the Experimental Biology Meeting, San Diego, CA.

Oschman, J.L. (2000). Energy medicine: The scientific basis of bioenergy therapies. Philadelphia: Churchill Livingstone.

Panov, V., Kichigin, V., Khaldeev, G., Klyuev, A., Testov, B., Yushkova, T., et al. (1997). Torsion fields and experiments. Journal of New Energy, 2(3 & 4), 29–39.

Reddy, G.K. (2004). Photobiological basis and clinical role of low-intensity lasers in biology and medicine. Journal of Clinical Laser Medicine and Surgery, 22(2), 141–150.

Rojavin, M.A., Cowan, A., Radzievsky, A.A., & Ziskin, M.C. (1998). Antipruritic effect of millimeter waves in mice: Evidence for opioid involvement. Life Sciences, 63(18), PL251–PL257.

Rojavin, M.A., & Ziskin, M.C. (1998). Medical application of millimetre waves. QJM: Monthly Journal of the Association of Physicians, 91(1), 57–66.

Russek, L., & Schwartz, G. (1996). Energy cardiology: A dynamical energy systems approach for integrating conventional and alternative medicine. Advances: The Journal of Mind-Body Health, 12(4), 4–24.

Sancier, K.M., & Holman, D. (2004). Commentary: Multifaceted health benefits of medical qigong. Journal of Alternative and Complementary Medicine, 10(1), 163–165.

Sisken, B.F., & Walder, J. (1995). Therapeutic aspects of electromagnetic fields for soft tissue healing. In M. Blank (Ed.), Electromagnetic fields: Biological interactions and mechanisms (pp. 277–285). Washington, DC: American Chemical Society.

Szabo, I., Manning, M.R., Radzievsky, A.A., Wetzel, M.A., Rogers, T.J., & Ziskin, M.C. (2003). Low power millimeter wave irradiation exerts no harmful effect on human keratinocytes in vitro. Bioelectromagnetics, 24(3), 165–173.

Tiller, W.A., Dibble, W.E., Jr., Nunley, R., & Shealey, C.N. (2004). Toward general experimentation and discovery in conditioned laboratory spaces: Part I. Experimental pH change findings at some remote sites. Journal of Alternative and Complementary Medicine, 10(1), 145–157.

Vallbona, C., & Richards, T. (1999). Evolution of magnetic therapy from alternative to traditional medicine. Physical Medicine and Rehabilitation Clinics of North America, 10, 729–754.

Vicent, S., & Thompson, J.H. (1929). The effects of music upon the human blood pressure. Lancet, 213, 534–538.

Zimmerman, J. (1990). Laying-on-of-hands healing and therapeutic touch: A testable theory. BEMI Currents, Journal of the BioElectroMagnetics Institute, 2, 8–17.

Membership Information

PNI and Complementary Therapies SIG Officers

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Angie Stengel, Director of Membership/Leadership
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