Tsay, S.L., Chen, H.L., Chen, S.C., Lin, H.R., & Lin, K.C. (2008). Effects of reflexotherapy on acute postoperative pain and anxiety among patients with digestive cancer. Cancer Nursing, 31(2), 109–115.

To investigate the effects of foot reflexology on pain and anxiety in patients undergoing surgery for digestive cancer

Patients were randomly assigned to the intervention group or a control group that received usual care. The intervention consisted of 20 minutes of foot reflexology using a standard protocol. A nurse certified to deliver this treatment provided it on day 2 after surgery, between one and three hours after the patient had received a dose of pain medication. Pain and anxiety were assessed at baseline and on postoperative day 5. A research assistant blinded to the randomization collected data. In the intervention group, pain was assessed before and after the intervention.

• The sample was composed of 62 patients.
• Mean patient age was 59.8 years (SD = 14.7 years).
• Of all patients, 52.5% were female and 47.5% were male.
• Patients had hepatocellular and gastric cancer. The types of surgeries performed were gastrectomy, hepatic lobectomy, or segmentectomy.
• Of all patients, 77% were married and 54% had more than a high school education.
• Patients with a history of chronic pain were excluded from the sample.

• Single site
• Inpatient
• Taiwan

Randomized single-blind controlled trial

• Short-Form McGill Pain Questionnaire
• Visual analog scale (VAS), to assess pain
• Hospital Anxiety and Depression Scale (HADS)
• Measures of Demerol use per day

• There were no differences between groups regarding main effects on pain or anxiety. However, when time was added as a factor in statistical analysis, a significant difference between groups developed. Time-dependent changes showed that perceived pain decreased more in the intervention group (p < 0.0001) than in the control group. Pain scores on the VAS were lower in the intervention group over time (p < 0.0001).
• The pain score immediately after the intervention declined by a mean difference of 12.09 mm (p < 0.001).
• There were no main effects relating to anxiety; however, time-dependent changes in anxiety declined more in the intervention group than in the control group (p < 0.0001).
• Overall pain and anxiety declined in both groups over time. In the intervention group, the average daily dosage of Demerol was significantly lower (p = 0.015) than in the control group. Perceived pain was correlated with anxiety (r = 0.43, p = 0.001).

Foot reflexology as provided in this study may be helpful in reducing postoperative pain.

• The study had a small sample size, with fewer than 100 patients.
• The study had a risk of bias due to no appropriate attentional control group. Although the authors described this as a double-blind study, patients who received the intervention knew that they were receiving it and those who did not receive it knew that they did not. Additional attention from the intervention or patient expectations associated with the intervention may have affected findings. Without an attentional control, the existence and extent of these effects are unclear.
• The study was done in a single country. Responses may not apply to all cultural groups.

This type of intervention may be helpful in managing pain in postoperative patients. The relationship between anxiety and pain suggests that efforts to reduce anxiety may affect patients’ perceptions of pain.