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[YanTing]

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Pain Management Nursing
February 2019 Volume 20, Issue 1, Pages 75–81

The effect of Therapeutic Touch on Back Pain in Adults on a Neurological Unit: An Experimental Pilot Study

Gerhard Mueller, Assoc-Prof, PhD, MSc, RN (1), Christoph Palli, MScN, BScN, RN (2), Petra Schumacher, MScN, BScN, RN (1)

1 UMIT e The Health & Life Sciences University, Department of Nursing Science and Gerontology, Tyrol, Austria
2 University Hospital Graz, Graz, Austria

Abstract

Background: Chronic back pain affects many aspects of everyday life and is a common reason for medical visits, leading to high direct and indirect health care costs. Innovative and cost-effective nonpharmacologic pain management methods should be promoted to ensure adequate treatment.
Aims: The aim of this pilot study was to investigate the pain-relieving effect of Therapeutic Touch in adult neurologic patients with back pain.
Design: A pretest–post-test randomized controlled trial.
Settings: A university hospital in Austria.
Participants/Subjects: Patients with back pain diagnosis (N = 29) on hospital admission.
Methods: A pilot study was conducted for 3 months. The control group (n = 14) received the pharmacologic pain management recommended by the World Health Organization; patients in the intervention group (n = 15) received additionally four Therapeutic Touch treatments on 4 consecutive days. The Quebec Back Pain Disability Scale and the Numeric Pain Rating Scale were used as outcome measures to evaluate activity domains affected by back pain and pain intensity.
Results: Pain improvement was found in the intervention group according to the mean score of the Quebec Back Pain Disability Scale (day 1: 72.53, standard deviation [SD] ± 14.10; day 4: 39.47, SD ± 8.77; p < .001). The Numerical Pain Rating Scale score averaged 4.33 points (SD ± 2.09) on the first day and 2.47 points (SD ± 1.12) on the fourth day. The long-term effect of Therapeutic Touch was significant and indicated a major effect (Pillai's trace = .641, F(3.12) = 7.1, p = .005, ηp2 = .641).
Conclusions: Therapeutic Touch seems to be a noninvasive nursing intervention for back pain management to provide more professional patient care.

Free full text:
https://www.painmanagementnursing.org/article/S1524-9042(17)30510-6/fulltext


Excerpts:

"The CAM modality of Therapeutic Touch was developed as a nursing intervention of laying on of hands by Krieger (1975)), with the intention to help or even heal the client by balancing the energy field (Keller and Bzdek, 1986, Krieger, 1975). Therapeutic Touch aims to harmonize, replenish, and improve the flow of the human energy field (Kunz, 2004) by removing blockages of a person's biofield (Hart, Freel, Haylock, & Lutgendorf, 2011). Hereby the healing energy of the life force Qi is directed through the practicing nurse's hands to promote healing and well-being of the patient (Anderson et al., 2016). The Therapeutic Touch treatment begins with centering, in which the nurse focuses consciously on the client with the sincere intention of wanting to help while at the same time activating mental and physical relaxation and establishing a state of expanded awareness. This is followed by the assessment of the current state of the client's energy field. The nurse guides his or her hands a few inches above the client's body from head to toe tips. During the treatment of imbalances, the flow of energy is directed and harmonized by calm and rhythmic hand movements, which supports the energetic balance. Next the energy field of the client is reassessed, and the treatment is repeated if needed. Finally an evaluation of the change in the energy field is carried out, and the client should rest (Therapeutic Touch International Association, 2014). If Qi is allowed to flow evenly and without blockages through the body's channels, a person feels emotionally and physically balanced (Kunz, 2004) and the pain experience can be positively supported (Anderson et al., 2016).

"Some nurses feel inept, frustrated, and unsatisfied if they cannot manage chronic pain effectively (Matthias et al., 2010). Yet adequate pain management is of utmost important to elevate pain symptoms and support patients (Martin et al., 2016). Thus Therapeutic Touch is a patient-centered and mindful approach that fosters the nurse-patient relationship (Anderson et al., 2016)."

[description of results from studies of TT and various types of pain and anxiety]

"Yet the effect of Therapeutic Touch on back pain has not been studied to date, and there are no published studies conducted in Austria evaluating the effect of Therapeutic Touch on back pain."

"Intervention

"Nine nurses from the neurologic unit with Therapeutic Touch basic training (60 lessons over 6 days) (Therapeutic Touch ooe, 2018) applied the Therapeutic Touch intervention. The treatment steps were standardized and took about 20 to 30 minutes to complete. The nurse used her hands to assess and rebalance the patient's entire energy field according to the following steps: (1) centering by consciously focusing on the patient and thereby activating a state of extended perception; (2) assessing the energy field by keeping the hands at a 5- to 10-cm distance from the patient's body to explore for energy deficits or increases and negative energy; (3) treatment of affected areas by modulating, balancing, and directing the energy in its flow and symmetry, treating the person holistically with the aim of promoting free energy flow; and (4) evaluation of the energy field and completion of the treatment (Therapeutic Touch ooe, 2018)."

[Discussion]

"The nonpharmacologic intervention Therapeutic Touch may offer back pain patients an alternative method and gives support not only on a physical level but also may positively influence psychological factors that contribute to the development and chronification of back pain (Aghabati et al., 2010, Kunz, 2004). The present pilot study found the beneficial effect of Therapeutic Touch in reducing back pain in neurologic patients over a 4-day period...A similar study by Decker et al. (2012)) evaluated Healing Touch, a similar energy healing modality, in non–community-dwelling older adults (N = 20) with persistent pain. The study reported statistically nonsignificant improvements in pain and activities of daily living. However, the quality of life decreased in the intervention group receiving Healing Touch treatment (Decker et al., 2012). Those statistically nonsignificant results are not in agreement with present study's results, which present a reduction of the QBPDS score from 72.53 (SD ± 14.10) to 39.47 (SD ± 8.77) points in the intervention group, indicating an improvement in the activities of daily living. In the control group the mean QBPDS score barely changed between the baseline and endpoint measurement. The results are also supported by Lin and Taylor (1998)), who reported a significant before and after effect of Therapeutic Touch treatment on pain in elderly patients (n = 95). Midilli and Eser (2015)) reported significant differences (p < .001) in pain intensity measured on a 0-10 scale in post–cesarean delivery patients (n = 45) receiving Reiki intervention, another biofield therapy (Henneghan & Schnyer, 2015)...Other studies also support the pain-relieving effect of Therapeutic Touch in cancer patients (Cook et al., 2004, Post-White et al., 2003). This positive trend toward the effectiveness of Therapeutic Touch has also been reported in palliative and end-of-life care patients (Henneghan & Schnyer, 2015), although precise conclusions on the effectiveness of Therapeutic Touch in reducing pain cannot be drawn. The quality of studies, applied methods, and mixed and small populations samples limit the significance of the compared study results (Henneghan & Schnyer, 2015), as well as the present pilot study results."

"Study Limitations

"The study results are not representative because of the positive selection process of patients who participated in the investigation."

"As another study limitation, the placebo effect needs to be mentioned. Several factors play an important role in the context of the placebo effect's impact on pain relief, such as patients' expectations for the subsequent treatment or cure, physician-patient interaction, therapeutic environment, and even empathy (Brody & Brody, 2011). Studies that also compared mock Therapeutic Touch for pain relief proved a significant effect that cannot be explained solely by the patient's expectations and thus differentiates Therapeutic Touch from a placebo effect (Aghabati et al., 2010, Gordon et al., 1998, Lin and Taylor, 1998). This was also presented by Keller and Bzdek (1986)), who reported significant tension headache pain level reduction with Therapeutic Touch compared with a placebo stimulation version of Therapeutic Touch (Keller & Bzdek, 1986). In this present study, however, a placebo Therapeutic Touch intervention was not possible because the Therapeutic Touch treatments took place during the regular nursing daytime shift. There were no additional time or personnel resources available to train unit nurses on performing a placebo Therapeutic Touch intervention."

"Conclusions

"This pilot study presents first results on the effectiveness of Therapeutic Touch in reducing back pain in adult neurologic patients. Therapeutic Touch seems to be a noninvasive, cost-effective method to provide more professional patient care. Another aspect of Therapeutic Touch is the presence of a nurse in the patient's room for a longer period. The nurse's daily routine rarely allows enough time for longer conversations with or without patient care. Therefore Therapeutic Touch offers nurses a nonpharmacologic alternative intervention for pain management and support of their patients."

"Clinical Implications

"Therapeutic Touch has established itself as a patient-demanded CAM modality to complement general nursing interventions. Therapeutic Touch can support conventional pharmacologic methods to reduce the pain experience of affected patients. The implementation of Therapeutic Touch requires time resources for trained, holistic, and empathic nurses to apply this cost-effective and alternative method to elevate back pain symptoms of patients."

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Comments:

1. The points discussed in "Study Limitations" preclude any conclusions of effectiveness.  As the authors admit, the patients in the study may have been predisposed to thinking therapeutic touch would be beneficial.  In addition, there was no control for the placebo effect.  This was what Edzard Ernst refers to as the A + B versus B trial design, almost guaranteed to produce positive results.

2. The study is described as "An Experimental Pilot Study."  However, according to
https://nccih.nih.gov/grants/whatnccihfunds/pilot_studies

"A pilot study is defined as 'A small-scale test of the methods and procedures to be used on a larger scale' (Porta, Dictionary of Epidemiology, 5th edition, 2008). The goal of pilot work is not to test hypotheses about the effects of an intervention, but rather, to assess the feasibility/acceptability of an approach to be used in a larger scale study. Thus, in a pilot study you are not answering the question 'Does this intervention work?' Instead you are gathering information to help you answer 'Can I do this?'”

So it is inappropriate for the authors to be commenting on the effectiveness of therapeutic touch in their study.

More importantly, they did not show that they can carry out a proper study.  They admit that they wanted to do a placebo control but "There were no additional time or personnel resources available to train unit nurses on performing a placebo Therapeutic Touch intervention."

3. As usual in such papers, there is no mention of the fact that therapeutic touch is inconsistent with scientific knowledge.

[Thymian]

ALL posts of the last 4 days are gone. Some idiot hoster admins spoiled it completely. May they roast in hell.