Print

[YanTing]

Analgesic Effects of Reflexology in Patients Undergoing Surgical Procedures: A Randomized Controlled Trial

Journal of Alternative and Complementary Medicine 24(8)809-815 (2018)

Samuel Attias, MPH,1,2 Keren Sivan, MD,3 Ofri Avneri, DRefl,1 Avigail Sagee, DRefl,1 Eran Ben-Arye, MD,4,5
Ofra Grinberg, BA, RN,6 Gideon Sroka, MD,5,6 Ibrahim Matter, MD,5,6 and Elad Schiff, MD1,3,7

(1-7 = various institutions in Haifa, Israel)

Abstract

Objective:
Inadequate treatment of pain in patients undergoing surgery is associated with unsatisfactory perioperative outcomes. The aim of this study was to examine the role of reflexology in addition to standard analgesic treatment in postoperative pain management.

Design:
This was a prospective, unblinded pragmatic controlled trial.

Setting/Location:
Study participants included patients who were admitted to the general surgery department.
Interventions: Patients in the intervention group received reflexology while standard analgesic care was administered similarly in both groups.

Outcome measures:
Pain intensity at rest and in motion was evaluated using visual analog scale (VAS [0–10]) at baseline, and 60–90 min after treatment.

Results:
Pain reduction was clinically and statistically significant in the reflexology group, both for pain at rest (from mean VAS of 4.4 to 3.1, N=77, p<0.0001) and for pain in motion (from 6.2 to 4.2, N=77, p<0.0001). In the control group, pain at rest was not reduced at follow-up (from 4.7 to 4.6, N=87, p=0.92), nor was pain in motion (from 5.8 to 5.7, N=87, p=0.65). Comparison of mean difference for pain showed significant improvement in the reflexology group compared to the standard of care group (p<0.0001). The most significant pain reduction in the reflexology group was observed among patients who had moderate-severe baseline pain (VAS >4).

Conclusion:
Adding reflexology to standard analgesic care is effective in reducing postoperative pain at rest and in motion, especially for patients experiencing moderate to severe pain.

https://www.liebertpub.com/doi/10.1089/acm.2017.0167


Excerpts:

Reflexology is a noninvasive and safe treatment method based on the principle that the feet represent a map of the entire body and that distant parts of the body can be treated by manipulation of the feet.3 A number of studies examined the impact of reflexology on pain measures. A study comparing the effectiveness of reflexology to that of ibuprofen in treating menstrual pain found a significant preference for reflexology with respect to both pain duration and pain intensity (as measured by visual analog scale [VAS]).4 Babajani et al. reported the effect of reflexology on pain upon chest drain removal following open heart surgery and demonstrated a reduction in pain following reflexology treatment.5 However, a number of published clinical studies did not demonstrate reflexology to be any more effective than nonspecific massaging of the feet.6–8 Some evidence in the literature indicates that reflexology is beneficial in diminishing pain, but the literature is scanty both in terms of the number of articles and quality of research methodology.6 Because reflexology is a practical and safe form of intervention that does not require many resources, it may serve as a potential treatment to manage postoperative pain control. In this study we examine the use of reflexology as a method for alleviating acute postoperative pain."

"Five experienced reflexologists formulated the therapeutic reflexology protocol. All therapists studied reflexology for 2 years, had at least 5 years of experience as reflexologists in ambulatory settings, and 2 years in treating in-patients. Three of the five reflexologists administered the treatments in this study. The therapeutic protocol included a preparatory period consisting of several minutes of gentle and nonspecific foot massage, followed by a shift to the reflex points regarded according to reflexology as representing the spinal column, sinuses, and the solar plexus for relaxation purposes.11 After that, the treatment focused on the pain by massaging the reflex point associated with the target organ and reflex points associated with the affected system according to reflexology maps (e.g., esophagus, stomach, and intestine reflex points after intestinal surgery). In addition, reflex points of the areas that innervate the target organ were also massaged. The treatment lasted around 20 min."

"The reflexology treatment involved the use of a reflexology cream comprising the following components: coconut oil, sweet almond oil, shea butter, cera alba, isopropyl myristate, lanolin, propyl parabenmethyl paraben, phenoxy ethanol, butylated hydroxytoluene, and peppermint oil."

"The research results point to a large improvement in level of pain at rest and in motion after reflexology in addition to standard analgesic treatment compared to standard drug treatment only."

"Another limitation is the lack of a sham reflexology group, that is, a group that undergoes nonspecific foot massage. It can be assumed that a heightened placebo effect would emerge in individual treatments merely from the human contact."

"Drug treatment was administered as customary in the department, and the pain assessments in the control group were not at set times in accordance with the drug treatment but rather were random. It is possible that some of the effect of reflexology on pain scores could be residual pain management from pain medications. However, this is exactly the point of integrative care. Ultimately, we are less interested in whether integrative care can, or should, replace other forms of pain management but rather can it be used as safely and effectively as current pain management approaches.20"



Comments: as usual, the authors don't mention that reflexology is inconsistent with scientific knowledge.  They do discuss the possibility of placebo effects due to human contact (maybe here they are also including the effects of massage), but do not discuss the presence of scents associated with the various oils employed, which could enhance the placebo effect.

Since there was not adequate control for placebo effects, the conclusion that reflexology is effective is not justified.