A Foot Massage Feels Good, But Can It Help With Chronic Pain?

There's nothing like coming home from a hard day and having someone rub your feet; but can reflexology - the practice of applying pressure to specific parts of the hands and feet for therapeutic purposes - be used for pain management? That was the question that Nancy Stephenson, Ph.D., R.N. from the East Carolina School of Nursing and Jo Ann Dalton, R.N., Ed.D. from the University of North Carolina set out to answer by reviewing the available medical literature. They published their review in the June, 2003 issue of the Journal of Holistic Nursing.

As the popular media - and this publication - has reported, millions of Americans suffer from chronic pain and are increasingly turning to complementary and alternative therapies either to supplement - or even replace - traditional medicine. In fact, according to the American Pain Foundation, over two-thirds of Americans living with chronic pain have sought out alternative treatments.

Given the increased use of alternative therapies, it is natural that they have come under increased scientific scrutiny. While many alternative approaches have only anecdotal evidence to support their use, some, like acupuncture, have shown promise when put into the scientific spotlight of more rigorous study. The scientific results others, such as distant healing techniques, have not been as promising.

Like acupuncture, reflexology originated in the East and has been used for thousands of years. There are historical records of reflexology being used in both Egypt and China as far back as 2000BC. Also like acupuncture, the philosophy behind reflexology lies in the concept of energy meridians which run through the human body. Applying pressure to specific spots on the hands and feet - reflex points - can influence the flow of energy and create a sense of calmness and wellbeing. The specific reflex points on the hands and feet directly correspond to organs and other body parts, so there is essentially a map of body parts on each foot and hand.

Reflexology was popularized in the US by a physical therapist named Eunice Ingham. Ingham began using reflexology techniques and over the course of treating hundreds of people became convinced there was a connection between reflex points in the feet and other parts of the body. She published a book on the subject and the Ingham method of reflexology was born. Today her method is championed by her nephew and taught widely around the world.

As with acupuncture, Western scientists have tried to explain reflexology in their own terms. Some researchers have applied the Gate Control Theory of Pain to build a theoretical basis for the benefits of reflexology. The Gate Control Theory states that the perception of pain is a complex phenomena which involves the interaction of several factors, including things like emotion, attention, etc. The theory states that as pain signals travel from the peripheral nerves, through the spine, and to the brain, they pass through a series of gates. Different factors can control these gates and either allow pain signals to pass through freely or restrict their passage.

So, for example, if a person is intensely concentrating on work - like writing an article - their chronic pain level may be low because the brain has closed some the pain gates in order to concentrate on the task. Applying this theory to reflexology, some believe that the pressure signals from the feet and hands are carried along a specific type of nerve fiber, which when active shuts down the pain signals which flow on a different type of nerve fiber. In other words, the body doesn't feel both the pressure and pain at the same time, so by applying one, you can reduce the other.

Unfortunately, despite a theory grounded in current pain concepts, like many alternative therapies, there are too few rigorous scientific studies to assess the effectiveness of reflexology beyond general stress relief. Stephenson and Dalton identified 18 research studies in the English language literature and reviewed 17 of them. A large number of the studies examined the use of reflexology to treat non-pain conditions. For example, a large, retrospective study from China examined over 8,000 cases involving a variety of conditions and concluded that reflexology was significantly effective for conditions influenced by spiritual, psychological, environmental, dietary, and metabolic factors, but not for acute conditions.

The team was, however, able to identify several studies which looked at pain oriented conditions with mixed results. One study involving 35 women showed that weekly 30-minute reflexology sessions were able to significantly reduce premenstrual symptoms. However, a study which examined the use of reflexology to help with pain after knee replacement surgery found that the reflexology was no better than a placebo. Similarly, a study involving reflexology and people with Irritable Bowel Syndrome (IBS) found that reflexology provided no relief.

The results from studies involving migraine headaches and breast and lung cancer are even less clear. A study of 220 people with migraines showed that reflexology treatments resulted in improved well-being, energy levels, and the ability to understand the cause of their headaches. However, the study was not rigorously designed and Stephenson and Dalton point out that the reflexology may not have been the reason for the improvement.

A recent study looked at the effect a single reflexology session had on the pain and anxiety of breast and lung cancer patients. Twenty three patients received a 30-minute reflexology treatment and also a 30-minute control treatment. The study found that the reflexology resulted in a significant decrease in pain for the breast cancer patients in one measure used (a descriptive survey), but not in pain as measured on a simple Visual Analog Scale. However anxiety, as measured on a simple Visual Analog Scale, was significantly reduced following the reflexology for both the breast and lung cancer patients.

Unfortunately for now, it is clear that much more research is required to see if reflexology can be effective in helping any or all painful conditions. The good news is that since the technique is non-invasive and does not involve drugs, it is hard to imagine how it could make anything worse. For those interested in trying it, the International Institute of Reflexology offers certification to providers and referrals are available through their web site (www.reflexology-usa.net). To become certified, practitioners must undergo 100 hours of study, 100 hours of documented practice sessions and pass both a written and practical exam.

For More Information, Visit:
The International Institute of Reflexology

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