Therapeutic Touch

Therapeutic Touch

PEP Topic 
Acute Pain
Description 

Therapeutic touch (TT), or healing touch, is an energy therapy involving movement of the practitioner’s hands 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, and then moves his or her hands above the patient’s body, not actually touching the body (Kelly, Sullivan, Fawcett, & Samarel, 2004). Researchers have studied therapeutic touch as an intervention for the treatment of 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

Research Evidence Summaries

Aghabati, N., Mohammadi, E., & Pour Esmaiel, Z. (2010). The effect of therapeutic touch on pain and fatigue of cancer patients undergoing chemotherapy. Evidence-Based Complementary and Alternative Medicine, 7, 375–381.

doi: 10.1093/ecam/nen006
Print

Study Purpose:

To examine the effect of therapeutic touch (TT) on pain and fatigue in patients undergoing chemotherapy.

Intervention Characteristics/Basic Study Process:

Patients were randomized to one of three groups:  the TT group; the placebo group, which underwent a procedure that mimicked TT; or the control group, which received standard treatment. Interventions were used for five days. Patients in the TT group received 30 minutes of TT delivered by a trained researcher. The same researcher delivered all interventions.

Sample Characteristics:

  • The study was comprised of 90 women (30 patients in each group).
  • Mean age was 36.86 years in the TT group, 42.70 years in the placebo group, and 43.30 years in the control group.
  • All patients were receiving inpatient cancer treatment.

Setting:

  • Three inpatient units (Whether they were at one site or multiple sites is unknown.)
  • Iran

Phase of Care and Clinical Applications:

  • Patients were undergoing the active treatment phase of care.
  • The study has clinical applicability for end of life and palliative care.

Study Design:

The study was a randomized, controlled trial with an intervention group and a usual care control.

Measurement Instruments/Methods:

  • 10-point, 10-cm visual analog scale (VAS) (patient marked line for pain score)   
  • Rhoten Fatigue Scale (RFS), 0 to 10 scale (0 = no fatigue, 10 = as much fatigue as I can bear)

Results:

  • The pain scores of the TT group were lower than the pain scores of the placebo and control groups (p = 0.04).
  • The fatigue scores of the TT group were lower than the scores of the placebo and control groups (p = 0.002).
  • On some days, the scores of the placebo group were significantly lower (p < 0.05) than the scores of the control group.
  • At all times, the fatigue scores of the TT group were lower than the scores of the placebo and control groups (p < 0.05).

Conclusions:

TT was more effective at decreasing pain and fatigue than were placebo and control treatments. The placebo arm showed "control" that was superior to that in the control group.

Limitations:

  • The study had a small sample size, with less than 100 patients.
  • The sample was comprised of Muslim women in Iran, which may affect the applicability of the findings.
  • The authors did not describe the actual intervention.

Nursing Implications:

TT may decrease pain and fatigue scores in patients undergoing chemotherapy. The fact that a therapist must receive significant training to deliver TT may affect the practicality of the intervention.

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.

Jain, S., & Mills, P. J. (2010). Biofield therapies: helpful or full of hype? A best evidence synthesis. International Journal of Behavioral Medicine, 17, 1–16.

doi: 10.1007/s12529-009-9062-4
Print

Purpose:

To determine whether biofield therapies affect positive health outcomes and reduce disease symptoms.

Search Strategy:

Databases searched were PubMed, CINAHL, PyscINFO, and Allied and Complementary Medicine (AMED).

Search keywords were spiritual healing, subtle energy, energy healing, biofield healing, external qi therapy, emitted chi, emitted qi, qi therapy, Johrei, pranic healing, polarity therapy, Reiki, therapeutic touch, and healing touch. Investigators also manually searched the reference sections of studies and review papers.

Studies were included if they

  • Were published in a peer-reviewed journal in the English language
  • Used a proximally practiced (that is, practiced with the practitioner and client in the same room) biofield-based modality and included quantitative endpoints
  • Were randomized, controlled trials (RCTs) with a within-subject design.

Studies were excluded if they related to distant healing or intercessory prayer; integrated modalities that were not biofield-based modalities with biofield-based modalities in such a way that the interventions could not be separated; were animal, plant, and/or in vitro studies; were clinical studies with group assignment but without randomization; were purely descriptive studies; or were unpublished dissertations.
 

Literature Evaluated:

  • The number of references retrieved was 88.
  • Investigators evaluated studies by means of an evaluation quorum that used a checklist of guidelines.
  • Ten studies examined the outcomes associated with the use of biofield therapies for patients with cancer.
     

Sample Characteristics:

  • The number of studies analyzed was 66.  
  • The authors did not report the total sample size or the sample size range across studies.
  • The sample included patients with pain; hospitalized and postoperative patients; and patients with dementia, cardiovascular issues, and cancer.
     

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Results:

The authors presented results according to type of patient and levels of evidence.

  • Pain:  The analysis revealed Level I evidence to support biofield therapies as a means of reducing the intensity of pain; Level 4 evidence of affecting comprehensive pain assessment; and Level 4 evidence on affecting anxiety and depression. The analysis also revealed that biofield therapies could have positive effects on health-related quality of life.
  • Cancer:  The analysis revealed Level 2 evidence to support biofield therapies as a means of reducing acute pain in patients with cancer; Level 4 of reducing chronic pain; Level 4 of affecting fatigue; Level 4 of affecting quality of life; and Level 4 of affecting physiological measures of relaxation response.
  • Hospitalized and Postoperative Patients:  The analysis revealed Level 2 evidence to support biofield therapies as a means of reducing anxiety and Level 2 of reducing pain. The evidence that the analysis revealed about the effect of biofield therapies on depression and functional or autonomic outcomes was insufficient to allow conclusions.
  • Dementia:  The analysis revealed Level 2 evidence to support biofield therapies as a means of reducing negative behavioral symptoms associated with dementia.
  • Patients with Cardiovascular Issues:  The analysis revealed Level 4 evidence to support biofield therapies as a means of reducing anxiety and Level 4 of reducing diastolic blood pressure. Study quality and duration of each treatment session were not associated with the number of positive outcomes; however, the total number of treatment sessions was positively associated with the number of positive psychological outcomes.

Conclusions:

Proximally practiced biofield therapies are promising complementary interventions as means of reducing pain intensity in multiple populations, reducing anxiety in hospitalized populations, and reducing agitated behaviors in patients with dementia. The long-term effects of the therapies on fatigue and autonomic nervous system activity are unclear.

Limitations:

  • The review was systematic but not a meta-analysis.
  • The authors relied on p-values versus effect size.
  • Nonquantitative studies were not included.

Nursing Implications:

Future research should compare biofield therapies with empirically supported treatments for specific conditions.

Sahawneh, L.J.F. (2011). Effectiveness of therapeutic touch on pain management among patients with cancer -- literature review. Middle East Journal of Nursing, 5(4), 21–24.

doi: 10.5742/MEJN.2011.54047
Print

Purpose:

To conduct a systematic review to evaluate the effectiveness of therapeutic touch (TT) as a complementary or alternative means of managing the pain of patients with cancer

Search Strategy:

  • Databases searched were PubMed, EBSCO, and Medscape.
  • Search keywords were therapeutic touch, cancer pain, and pain management.
  • Articles were included if they
    • Reflected observational or experimental studies or investigations involving TT as one option or as one of several complementary or alternative modalities to relieve the pain of any type of cancer
    • Reflected a study that included random assignment to placebo or control
    • Were abstracts published, in English only and between January 2000 and April 2010, in a peer-reviewed journal
  • Studies were excluded if they involved TT as a treatment for pain unrelated to cancer.

Literature Evaluated:

  • The total number of references retrieved was 46.
  • Author used a systematic and qualitative evaluation method.
     

Sample Characteristics:

  • The number of studies included in the analysis was 10. The list of references includes only nine studies, however.
  • The total sample size and sample range across studies are uncited.
  • Key sample characteristics are uncited.

 

Conclusions:

TT is a therapy that may be useful in decreasing cancer-related pain and improve quality of life, but TT is often overlooked.

 

Limitations:

The systematic review was not thorough; reported findings were not comprehensive.


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