Therapeutic Touch

Therapeutic Touch

PEP Topic 
Chronic Pain
Description 

Therapeutic touch (TT) or healing touch is an energy therapy where the practitioner’s hands move through the patient’s energy field to assess and treat energy field imbalances (Shames & Keegan, 2000). The specially trained practitioner deliberately “centers” intention from an external focus to an internal focus of calm, then moves his or her hands over the patient’s body, but does not actually touch the body. TT has been studied as an intervention for anxiety and pain in patients with cancer.

Shames, K.H., & Keegan, L. (2000). Touch: Connecting with the healing power. In B.M. Dossey, L. Keegan, & C.E. Guzzetta (Eds.), Holistic nursing: A handbook for practice (3rd ed., p. 614). Gaithersburg, MD: Aspen.

Effectiveness Not Established

Systematic Review/Meta-Analysis

Bardia, A., Barton, D.L., Prokop, L.J., Bauer, B.A., & Moynihan, T.J. (2006). Efficacy of complementary and alternative medicine therapies in relieving cancer pain: A systematic review. Journal of Clinical Oncology, 24, 5457–5464.

doi: 10.1200/JCO.2006.08.3725
Print

Purpose:

To evaluate the efficacy of various complementary and alternative medicine (CAM) therapies to reduce cancer pain

The type of article is systematic review.

Search Strategy:

  • Databases searched were MEDLINE, EMBASE, CINAHL, Allied and Complementary Medicine (AMED), and the Cochrane Library up to August 2005. Investigators also searched reference lists from articles to identify relevant studies.
  • Search keywords were cancer, pain and alternative medicine, and neoplasm, as well as terms for major individual CAM therapies.
  • Studies were included in the review if they were randomized clinical trials (RCTs) that had a CAM intervention for cancer pain.
  • Exclusion criteria were not cited.

Literature Evaluated:

The initial search identified 101 articles, of which investigators excluded 85. Investigators included an additional two articles, which were found through manual scans of reference lists. Investigators appraised articles by using the Jadad scale.

Sample Characteristics:

  • The final sample included 18 studies reporting on 1,499 patients.
  • The average sample included less than 100 patients; median sample size was 54 patients.

Results:

  • Acupuncture: Investigators evaluated three trials, of which one was a high-quality study that used auricular acupuncture to treat 90 patients. Compared to the placebo group, the treatment group had a significant decrease in pain intensity that lasted two months.
  • Mind-body interventions: Investigators assessed five trials. Two of these were trials of intermediate quality in which support groups were effective in decreasing pain. Interventions included group supportive psychotherapy, hypnosis, and support groups. Two trials concluded that relaxation and imagery were effective in reducing pain. Researchers obtained no greater relief by adding cognitive behavioral therapy to relaxation or imagery.
  • Music: Assessment revealed that the three trials were of poor quality. Results were mixed. Effects measured were of very short duration.
  • Herbal mixtures: Two trials examined different herbal supplements. Both trials were of poor quality, and one did not report actual statistical results. Authors could draw no meaningful conclusions from this information.
  • Massage therapy: The four trials involving massage therapy had mixed results in terms of efficacy. Most of these trials had very small sample sizes, and none found intervention effects that lasted longer than four weeks.
  • Healing touch or Reiki: Two trials involved these interventions. Results did not warrant conclusions about effectiveness.

Conclusions:

The result of this systematic review was that none of these interventions can be recommended as effective. The most promising therapies appear to be mind-body interventions. In particular, hypnosis and relaxation might have some effect in decreasing cancer pain. Effect may be limited by cognitive impairment caused by cancer or cancer treatment. Support groups may have some positive effects. Whether these benefits are due to increased patient awareness, with more frequent visits to care providers, better compliance with medication regimens, or as a result of group interaction and social or emotional support is unclear. One study found that benefit occurred only in those patients who were more distressed at baseline. It is possible that effect sizes of therapies may be more discernible among patients with higher pain ratings, demonstrating a floor effect related to the symptom of pain.

Limitations:

  • Most trials were of low quality, with missing data and incomplete reporting. This fact made extracting sufficient usable information difficult.
  • Few studies in the analysis examined a specific intervention.

Nursing Implications:

Current evidence does not support the efficacy of the cited CAM interventions in the management of pain of patients with cancer. Methodologically strong research that incorporates appropriate attentional and sham controls, sufficient sample sizes, and longer duration of follow-up is needed.

Jackson, E., Kelley, M., McNeil, P., Meyer, E., Schlegel, L., & Eaton, M. (2008). Does therapeutic touch help reduce pain and anxiety in patients with cancer? Clinical Journal of Oncology Nursing, 12, 113–120.

doi: 10.1188/08.CJON.113-120
Print

Purpose:

To examine research about the effectiveness of therapeutic touch in decreasing the pain and anxiety of patients with cancer

Search Strategy:

  • Databases searched were PubMed, CINAHL, and the Cochrane Library.
  • Search keywords were healing touch, therapeutic touch, cancer, and pain and anxiety.
  • Studies were included if they
    • Researched the use of therapeutic touch in the context of any type of cancer.
    • Used therapeutic touch as the independent variable and pain or anxiety as the dependent variable.
  • Exclusion criteria were not cited.
  • Although the initial search strategy did not include the search keywords healing touch or Reike, these terms were included later.

Literature Evaluated:

  • The study does not cite the number of studies retrieved or how authors assessed the studies for inclusion.
  • Studies were organized, according to the quality of the evidence, by using the seven-level rating system that Melnyk proposed.

Sample Characteristics:

  • Authors included 12 studies in the analysis.
  • Sample size across all 12 studies was 6,066 patients. The range of sample sizes was 9–5,457.

Results:

  • Authors identified only one study as a level 1 study. This study, a systematic review of 18 studies, concluded that, though evidence showed therapeutic touch to be a promising intervention, the evidence to support recommending therapeutic touch was inadequate.
  • Three studies reported positive results, demonstrating that therapeutic touch was associated with significant improvement in physical and psychological health.
  • The analysis yielded no results regarding the direct effect of therapeutic touch on pain or anxiety. Studies in this regard, three cohort or case control studies, were of low quality. Authors assessed them as level 3 nonrandomized controlled trials. One of these trials reported significant reduction (p = 0.03) of measured anxiety during the perioperative period.

Limitations:

The authors report that research relating to therapeutic touch indicates that the therapy helps to reduce pain and anxiety; however, the evidence that the research provides is very weak. Few studies showed statistically significant results, and several studies did not directly measure either variable. The rating scale used does not take sample size into account. As a result, a study rated level II included only 20 patients. Even with this rating scale, most studies analyzed were of low quality. Although the purpose of this study was to summarize the research, the authors incorporated opinion and review articles that were in support of therapeutic touch.

Nursing Implications:

The evidence to support the efficacy of therapeutic touch, as a means of reducing the pain and anxiety of patients with cancer, is weak because the research about this topic is of low quality. Many investigators believe that therapeutic touch and related interventions are promising for patients with cancer and that the interventions pose little risk. Delivering these interventions requires training, however. Some authors have noted that, compared to inexperienced practitioners, experienced practitioners achieve more significant results. Therapeutic touch is something to consider as an adjunctive treatment for the pain and anxiety of patients with cancer. However, therapeutic touch must be administered by a trained and experienced practitioner. Well-designed and appropriately powered research of the efficacy of therapeutic touch is warranted.

Research Evidence Summaries

Post-White, J., Kinney, M.E., Savik, K., Gau, J.B., Wilcox, C., & Lerner, I. (2003). Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies, 2, 332–344.

doi: 10.1177/1534735403259064
Print

Study Purpose:

To determine if massage therapy and healing touch were effective in reducing anxiety, mood disturbance, pain, fatigue, and nausea and in improving the relaxation and satisfaction with care of patients receiving chemotherapy treatment

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to one of three groups: therapeutic massage, healing touch, or caring presence. All received four weekly 45-minute sessions of the intervention and four weeks of standard care (control). After four weeks, patients were crossed over to another intervention or the control. Order of the intervention and usual-care control were randomized. Pre- and post-assessments of pain, nausea, and vital signs were done at each session. Assessments of intervention effects were done at the beginning and end of each four-week session. Therapeutic massage was provided in a standardized fashion, using a Swedish massage protocol. Healing touch followed a previously developed protocol incorporating centering, unruffling, magnetic unruffling, full-body connection, mind clearing, chelation, and lymphatic drain. Presence consisted of patients lying down for 45 minutes with relaxing music and the presence of a therapist. The therapist asked patients how they were feeling and if they had any questions. Conversation may or may not have occurred, according to the patient’s preference; the purpose of the therapist was to be attentive but to avoid therapy or physical intervention. The control condition consisted of usual care, which the authors did not describe.

Sample Characteristics:

  • The study reported on a sample of 164 patients.
  • Mean patient age was 57.4 years, with a range of 27–83 years.
  • The sample was 87% female and 13% male.
  • The most common cancer types were breast, gynecologic or genitourinary, gastrointestinal, hematologic, and lung.
  • The majority of patients had stage III or IV disease, and 50% were in the first month of chemotherapy treatment.
  • All patients had a score of at least 3 on a 10-point scale of symptom severity. The most frequently reported symptoms were fatigue, pain, anxiety, and nausea.

Setting:

  • Single site
  • Outpatient setting

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

A randomized, controlled, parallel-group, crossover design was used.

Measurement Instruments/Methods:

  • Symptom rating scales (0–10)
  • Brief Pain Inventory
  • Brief Nausea Index
  • Profile of Mood States
  • Satisfaction measure according to a four-point Likert-type scale

Results:

  • Of those who initially entered the study, 29% dropped out. Half of the dropouts were due to changes in the cancer treatment protocol; half were because patients wanted an intervention different from the one assigned. Those who dropped out had higher pain, nausea, mood disturbance, and fatigue at baseline (p < 0.05) than those who did not.
  • Massage and healing touch groups showed immediate post-session reduction of respiratory rate, heart rate, and blood pressure (p < 0.01), and these interventions were more effective (p < 0.01) in achieving these reductions than were control and presence conditions. Massage and healing touch were associated with pre- and post-session reduction in current pain (p < 0.001).
  • Over the four-week study period, mood disturbance decreased over time in all patients. Massage therapy, compared to the control condition, was more effective at reducing total mood disturbance (p = 0.004) and anxiety (p = 0.023). Healing touch reduced mood disturbance (p = 0.003) and fatigue (p = 0.028).
  • Mean pain scores in all cases declined over time.
  • There were no differences between groups in nausea or use of antiemetics.
  • There were no differences between groups in overall satisfaction. Massage and healing touch were associated with higher satisfaction with the intervention than was presence (p < 0.0001).

Conclusions:

Massage therapy and healing touch were more effective than presence alone or standard care in improving mood, reducing anxiety, pain, and fatigue and in reducing heart rate, blood pressure, and respiratory rate immediately postintervention.

Limitations:

  • The control condition may not have provided appropriate attentional control.
  • The study had risk of bias due to no blinding.
  • The anxiety measure was not a rigorous, valid tool; it was a 10-point scale.
  • The study had a large drop-out rate.

Nursing Implications:

Massage therapy and therapeutic touch can be beneficial to patients because the interventions induce physical relaxation and reduce pain, fatigue, and anxiety. In this study, these interventions were more effective in this regard than was therapeutic presence alone. Massage therapy and therapeutic touch are complementary therapies that nurses can consider and advocate for on behalf of patients who may benefit from them.


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