Touch therapies for pain relief in adults

 

Abstract

Background

Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (Healing Touch (HT), Therapeutic Touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use.

Objectives

To evaluate the effectiveness of touch therapies (including HT, TT, and Reiki) on relieving both acute and chronic pain; to determine any adverse effect of touch therapies.

Search methods

Various electronic databases, including The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and others from their inception to June 2008 were searched. Reference lists and bibliographies of relevant articles and organizations were checked. Experts in touch therapies were contacted.

Selection criteria

Randomized Controlled Trials (RCTs) or Controlled Clinical Trials (CCTs) evaluating the effect of touch on any type of pain were included. Similarly, only studies using a sham placebo or a 'no treatment' control was included.

Data collection and analysis

Data was extracted and quality assessment was conducted by two independent review authors. The mean pain intensity for completing all treatment sessions was extracted. Pain intensity from different pain measurement scales were standardized into a single scale. Comparisons between the effects of treatment groups and that of control groups were made.

Main results

Twenty four studies involving 1153 participants met the inclusion criteria. There were five, sixteen and three studies on HT, TT and Reiki respectively. Participants exposed to touch had on average of 0.83 units (on a 0 to ten scale) lower pain intensity than unexposed participants (95% Confidence Interval: -1.16 to -0.50). Results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction. It is also apparent that these trials yielding greater effects were from the Reiki studies. Whether more experienced practitioners or certain types of touch therapy brought better pain reduction should be further investigated. Two of the five studies evaluating analgesic usage supported the claim that touch therapies minimized analgesic usage. The placebo effect was also explored. No statistically significant (P = 0.29) placebo effect was identified.

Authors' conclusions

Touch therapies may have a modest effect in pain relief. More studies on HT and Reiki in relieving pain are needed. More studies including children are also required to evaluate the effect of touch on children.

 

Plain language summary

Touch therapies (Healing Touch, Therapeutic Touch and Reiki) for the treatment of pain relief for adults

Touch therapies (Healing Touch, Therapeutic Touch and Reiki) have been found to be useful in pain relief for adults and children. Pain is a global public health problem affecting the lives of large numbers of patients and their families. This review aims to evaluate the effectiveness of touch therapies for relieving pain, and determine the possible adverse effects of touch therapies. Although the lack of sufficient data means that the results are inconclusive, the evidence that does exist supports the use of touch therapies in pain relief. Studies involving more experienced practitioners tend to yield greater effects in pain reduction. It is also apparent that studies with greater effects are carried out by highly experienced Reiki practitioners. Further investigation should be conducted on whether or not a more experienced practitioner or a certain type of touch therapy provides better pain reduction. The claim that touch therapies reduce analgesic usage is substantially supported. The placebo effect has been also widely explored. No statistically significant placebo effect has yet been identified except through one study on children. The effect of touch therapies on pain relief in children requires further investigation. No adverse effect has yet been identified. This review suffers from a major limitation: the small number of studies and insufficient data. As a results of inadequate data, the effects of touch therapies cannot be clearly declared. This review shows that there is still a need for higher quality studies on the effectiveness of touch therapies in pain relief, especially studies on Healing Touch and Reiki. Future studies should make a concerted effort to systematically document side effects and report the experience of the practitioners to allow for the evaluation of the relationships between treatment effect and experience of practitioners. Future experiments should also follow the CONSORT statement when reporting in scientific journals, which helps to substantiate the reliability and validity of quality assessments.

 

摘要

背景

觸摸療法緩解成年人的疼痛

疼痛是一個全球性的公共健康問題影響到大批病人及其家屬的生活。觸摸療法(癒合觸摸(HT) ，治療觸摸(TT)和靈氣)已經發現用來減輕疼痛，但有些回顧建議沒有充分的證據來支持使用這些療法。

目標

評估觸摸療法(包括HT, TT, and Reiki)對減輕急性和慢性疼痛的有效性;來確定觸摸療法的任何副作用。

搜尋策略

在各種電子數據庫，包括Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED 和其他資料庫從一開始到2008年6月進行了全面搜查。檢查參考文獻的清單和相關文章的參考書目。對觸摸療法的專家也進行了接觸。

選擇標準

評估涉及任何疼痛類型的隨機對照試驗(RCTs)或控制的臨床試驗(CCTs)被列入。同樣，有些研究只有使用的是安慰劑組或是沒有治療的控制組也被列入。

資料收集與分析

兩位獨立審查者評估列入審查的試驗的品質，並擷取數據。平均疼痛強度為完成所有的治療後去擷取。從不同的疼痛測量尺度轉化成單一標準的測量尺度來去表示疼痛強度。比較治療組和對照組的治療效果。

主要結論

24項研究，包含1153位受試者列入標準。分別有5項， 16項和3項研究HT， TT和Reiki。受試者接觸觸摸比未接觸受試者平均降低0.83單位(在0到10級)的疼痛強度(95 ％信賴區間：−1.16至−0.50)。較有經驗的治療者產生的結果似乎在減少疼痛有更大的效果。但同樣顯而易見的是，研究Reiki在減少疼痛有更大的效果。是否由有豐富經驗的從業人員執行或某些類型的觸摸療法帶來了更好的疼痛減輕，應該做進一步研究。5個之中的2個研究宣稱使用觸摸療法減少止痛藥使用。安慰劑的效應也被探討。安慰劑的效應也被探討，但安慰劑的效應(P = 0.29)在統計學上是無意義的。

作者結論

觸摸療法可能有適度的的止痛效果。進一步研究 HT和 Reiki 在減輕疼痛上是必要的。需要更多的研究來探討，其中包括評估兒童身上減輕疼痛也是需要的。

翻譯人

本摘要由三軍總醫院詹舜名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

觸摸療法(Healing Touch, Therapeutic Touch and Reiki)用於減輕成人疼痛：觸摸療法(Healing Touch, Therapeutic Touch and Reiki)被認為緩解成人和兒童的疼痛是有用的。疼痛是一個全球性的公共健康問題影響到大批病人及其家屬的生活。這次審查的目的是評估觸摸療法對減輕疼痛的有效性;並來確定觸摸療法的任何副作用。儘管缺乏足夠的數據，也就是說雖然結果無定論，但證據顯示支持使用觸摸療法來緩解疼痛。研究包含由更是豐富經驗的從業人員往往產生對減少疼痛有更大的效果。同樣的，研究包含更是豐富經驗的靈氣從業人員往往產生對減少疼痛有更大的效果。對是否更加有經驗的從業人員或某一類型的觸摸療法提供了更好的減少疼痛應該做進一步的研究。觸摸療法宣稱減少止痛藥使用並實質上給予支持。安慰劑的效應也已廣泛地探討。除了一項研究顯示做兒童有影響外，安慰劑的效應尚無統計學上意義。觸摸療法對緩解兒童的疼痛需要作進一步調查。至今尚未發現任何副作用。這項回顧有幾項重大限制：在研究數太小和不足夠的數據。也因為數據不足，無法明確宣稱觸摸療法的療效。這項審查顯示，仍然必需要有更高品質的試驗來研究觸摸療法對疼痛緩解的效果，特別是研究Healing Touch和Reiki的治療效果。未來的研究應作出協調一致的努力，來系統性記錄副作用的報告和從業人員的經驗，以便評估治療效果和經驗的從業人員之間的關係。未來的試驗還應當按照CONSORT聲明，在科學期刊發表時，將有助於可靠性和品質有效性的證實。