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By David Kiefer, MD, Editor
Clinical Assistant Professor, Department of Family Medicine, University of Wisconsin; Clinical Assistant Professor of Medicine, Arizona Center for Integrative Medicine, University of Arizona, Tucson
Dr. Kiefer reports no financial relationships relevant to this field of study.
SYNOPSIS: In a study of 90 men with cancer-related pain, the arm receiving seven sessions of therapeutic touch derived more benefit than a placebo group or a control arm of no intervention.
SOURCE: Tabatabaee A, et al. Effect of therapeutic touch on pain related parameters in patients with cancer: A randomized clinical trial. Mater Sociomed 2016;28:220-223.
Many modalities could be considered energy, or biofield, medicine (also referred to as touch therapies), including healing touch, therapeutic touch (TT), and Reiki.1 The effect of these treatments is being explored for many health conditions; pain, including cancer-related pain, is a common reason energy therapies are used.2,3 Tabatabaee et al studied the effect of TT in cancer patients who were suffering from pain, in part, because of the fact that the prevalence of cancer pain is high, as is cancer patients' use of complementary and alternative (CAM) medicine.
The study took place in Mashhad, Iran. Ninety men referred for oncology treatment were included in this trial if they met the criteria outlined in Table 1. Subsequently, these men were randomized into three groups: a TT group, a placebo group, and a control group. The TT touch group received a 10- to 15-minute session every three days for a total of seven sessions. During a session, the patient was brought to a quiet room, asked to close his eyes and breathe deeply as the TT practitioner used his/her hands to scan the biofield energy, perform an energy “cleansing,” and then administer positive energy treatments with his/her hands at a distance of 5-10 centimeters from the patient’s body. Similarly, the placebo group spent 10-15 minutes in a quiet room while a practitioner randomly moved his/her hands over the patient at a similar distance from the patient. The TT and placebo sessions were administered over a four-week period. The control group received no additional treatments other than standard medical care, which, of note, the TT and placebo groups also received. The authors collected demographic information, as was patients’ answers to the Brief Pain Inventory (BPI), for all patients. The BPI is a validated scale that rates pain's effects on general activity, mood, walking ability, interpersonal relations, and sleep.
The baseline characteristics of the three groups were statistically similar. For the BPI testing post-intervention, the TT group showed a statistically significant improvement compared to both the placebo group and the control group (P < 0.001). As the statistics were displayed (Table 2 in Tabatabaee et al's article), it is unclear of the significance for the baseline vs. post-intervention for the TT group, although it appears that the BPI sub-groups all improved whereas baseline vs. post-intervention for placebo and control groups did not change. The authors noted that there was no statistically significant difference between the placebo and control groups post-intervention. Again, mentioned in the text but not displayed graphically, was the fact that the TT group had both less worsening of pain with walking over time, but also possibly an improvement in pain with walking over time; essentially, both the prevention of pain worsening and the treatment of existing pain that occurred with walking. There was no discussion of adverse effects in any of the groups, nor the estimate of any study participant as to which group they were assigned (relevant only to the TT and placebo groups, obviously). No dropouts were mentioned over the course of the trial.
Therapeutic, or healing, touch often is delivered as light or no-touch through the hands, that are meant to balance and promote the flow of energy in the human body.1,4,5,6 Such biofield therapies are described as “intentional” and “compassionate,” and holistically address the recipient's body, mind, and spirit.4 They have begun to be studied in a variety of medical conditions, which have shed light on their efficacy and confirmed their widely accepted safety. It could be argued that there is nothing more timely than the search for modalities to help patients with pain of any type, especially given the worldwide attention to the epidemic surrounding the use of narcotic pain medicines. In this study, TT was effective in lessening cancer-related pain in men across several sub-types of pain as per a validated pain scale. At the very least, this study should raise our eyebrows, if not change our practice or referral patterns to take advantage of its findings.
Yes, there were methodological flaws with this study. There was no discussion of blinding; patients might have been aware that they were in the placebo group unless the practitioners were masters at pretending they were delivering a biofield therapy. However, even if the patients benefited from the presence of a session when someone was in the room with them with their hands hovering close, there should have been some finding as compared to the control group. The lack of a difference between placebo and control, and the obvious benefit of the TT as per the authors’ statistical analysis, lends some credence that placebo was intact. Also, most studies have adverse effects of some sort, so the lack of mention makes us think that they did not collect data on that parameter. Such “risks” are an important part of a clinician’s risk-benefit analysis and ultimate incorporation of a therapy in clinic and counseling about its use. Clinicians need to know exactly what to tell patients about a treatment. Furthermore, there was no mention of the type of cancer nor the specific type of pain that study participants had. It’s difficult to imagine that headache and hip pain, for example, would be treated in the same way or would achieve the same magnitude of benefit. Even with these minor glitches, assuming that TT is well tolerated, clinicians absolutely should consider exploring the use of this modality for patients in pain, either as an adjuvant therapy or standalone treatment. The next important steps, after clarification of efficacy and safety from future clinical trials, will be to establish access (geographic, financial) with trained TT practitioners, an issue a bit beyond the scope of this article.
Integrative Medicine Alert’s executive editor David Kiefer, MD, reports he is a consultant for WebMD. Peer reviewer J. Adam Rindfleisch, MD, MPhil, AHC Media executive editor Leslie Coplin, and associate managing editor Jonathan Springston report no financial relationships relevant to this field of study.