It really may be the best medicine

Dr. Topher Stephenson, sitting ramrod-straight in the physician's archetypal white coat, knitted his brows and focused his empathetic brown eyes on three patients, one using a cane and another wearing a back brace. Chronic pain not only can affect the physical, the patients explained, it can decimate quality of life.

At one point, patient Eric Haynes couldn't help but cry.

"I'm just trying to deal with the pain and keep going," he told the group, a Proactive Pain Solutions class at Sacramento, Calif.'s Mercy Midtown Medical Building. "I don't want to do anything. ... But I don't want to give up on life, either."

On it went, sad stories of lives turned upside down, while Stephenson and Mercy behavioral health coordinator Pat Hanson offered soothing words and concrete coping skills. But near the end of the session, Stephenson looked at his watch and decided what everybody needed was a good laugh.

Seriously.

Stephenson, who specializes in physical medicine and runs the spine program at Mercy in Sacramento, also has become something of an adherent to a trend in integrative medicine known as laughter yoga, which promises to do for the psyche what bikram yoga does for muscles.

So he tells the group members to gird for a brief but restorative session of mirth. He has them extend an imaginary string with both hands across their mouths and says to raise it a bit and laugh.

"Ha-ha-ha-ha-ha ..."

"OK, that was a nice and easy warm-up," Stephenson said. "I don't want to hear belly laughs yet. Just keep your teeth closed and do two more."

"Ha-ha-ha ..."

"Now, I want you to really let it rip, OK?"

"HA-HA-HA-HA-WHOA-HA-HA-HA ..."

Laughter reigned. The whole vibe of the room changed from sorrow to joy, at least for a minute. Everyone was smiling and chuckling after Stephenson finished and dismissed the group.

"This has really helped me," said Haynes, who is unable to work because of a chronic back condition. "And it's fun to do."

BODY OF RESEARCH GROWING

Sure, a good belly laugh or two might temporarily distract chronic pain patients. But, skeptics might ask, what good could it really do?

Research looking at the connection between mind and body suggests that repeated doses of laughter can indeed lead to positive physical changes. Building on the lay research by 1970s best-selling author Norman Cousins, who eased his autoimmune disease by watching "Candid Camera" episodes, doctors at Loma Linda University in Southern California have documented the effects of laughter in double-blind studies.

In a paper presented at last month's meeting of the American Physiological Society, they found that the hormones beta-endorphins (which elevate mood) and human growth hormone (which builds immunity) increased significantly in patients exposed to "mirthful laughter."

Another study by the same doctors found that laughter reduced three key stress hormones -- cortisol, epinephrine and dopac -- by 38 percent to 70 percent. Significantly high levels of those three hormones have long been linked to compromised immune systems.

Stephenson was won over even before he became familiar with the scientific literature. In a break before starting medical school in the late 1990s, he attended clown college (Mooseburger University in Oklahoma) and graduated with honors. Using his alter ego, Bobo Doodlemeyer, Stephenson started a clown-care unit at the University of New Mexico Children's Hospital.

Bobo usually stays incognito as Stephenson goes about his day-to-day practice dealing with back- and neck-pain patients. But the laughter remains part of his prescription.

"I've found humor is a good tool," Stephenson said. "There are a whole lot of people with chronic pain who haven't laughed in a long time.

"When you get down to it, laughter promotes all kinds of good endorphins, which helps reduce pains and promotes deep breathing. A lot of these folks who are hurt just don't breathe well. Their breathing pattern is (shallow). Laughter gives you little squirts of dopamine, the feel-good reward chemical in the brain."

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