Does Therapeutic Touch reduce pain?

Does Therapeutic Touch reduce pain?

Abstract

Pain has a significant negative impact on those who experience it and is not always eased by analgesia. Complementary therapies such as Therapeutic Touch may provide an alternative solution for pain relief. While there have not been many studies into Therapeutic Touch, there is some evidence that it may reduce pain. Recent review articles that assessed Therapeutic Touch as a form of pain relief are discussed here.
Pain is a common symptom, which is estimated to affect nearly one in five adults in Europe (Fricker, 2003). There are many causes of pain, which can be acute such as following an injury or chronic as is the case in arthritis. Pain not only is a physical symptom, but can affect people’s psychological well being and can have a negative impact on quality of life, not to mention the economic consequences due to lost working days (Ventegodt & Merrick, 2005). However, even though the original source may appear to have resolved, pain can linger and does not always respond to conventional medical treatments (Ventegodt & Merrick, 2005). For these reasons it is important to explore other therapies as a means of providing pain relief. One such therapy is Therapeutic Touch.
Therapeutic Touch is where a therapist consciously uses their hands over a patient’s skin to help balance their energy fields (Rosa et al., 1998). It is based on the theory that there is a two-way flow of energy between any person and their environment and for good health the flows need to be in equilibrium. Tense feelings that can develop from a person’s emotional state can cause tension to build up in muscles, bones, joints and connective tissue, which can act as a blockage to the flow of energy and manifest itself as pain (Ventegodt & Merrick, 2005). Therapeutic Touch aims to provide a cure, not through working on individual tissues in the body, but through the person as a whole, enhancing their overall wellbeing (Ventegodt & Merrick, 2005).
While some hospitals in North America are already using Therapeutic Touch as part of their treatment programmes (So et al., 2008), the use of this complementary approach has not been widely studied. Embracing the concept of evidence based medicine, where therapies need to have demonstrated that they do indeed provide benefit and do not result in any harm, it is important that the effectiveness and safety of Therapeutic Touch is assessed.
A Cochrane Review in 2008 assessed 16 studies (either randomised controlled trials or clinical controlled trials) of Therapeutic Touch in relation to pain relief. It found that although a positive result was not seen in all studies, when considered as a whole there was a significant reduction in pain through this therapy, with one study highlighting that Therapeutic Touch may reduce the need for a patient to take analgesia (So et al., 2008). However, this review did highlight the need for further high quality studies in this area, particularly those involving children, as these were not well represented. It also emphasised that although Therapeutic Touch appears a safe therapy, it is still important that studies document any adverse effects.
Similar findings to the Cochrane Review were described by a literature review published in the Journal of Holistic Nursing (Monroe, 2009). While only five studies were deemed rigorous enough to be included, the results from four of them showed a significant positive impact of Therapeutic Touch on pain relief, particularly in the management of pain in
osteoarthritis, musculoskeletal pain and burns. However, again, further studies were recommended as necessary, including inclusion of a wider range of participants and investigating the effects of treatment frequency, duration and benefit for different types of pain. Little is known about the true mode of action of Therapeutic Touch, so this is another important avenue for further study. Despite not fully consistent results and calls for continued research, interestingly the author recommends that Therapeutic Touch currently be offered as a mode of pain relief, as it is considered to be a safe treatment.
Some studies of Therapeutic Touch and pain relief have also explored its benefit on emotional aspects such as depression and anxiety (Lin & Taylor, 1998; Marta et al., 2010; McCormack, 2009). While the results of studies have been mixed, some have shown a significant positive impact (Lin & Taylor, 1998; Marta et al., 2010), which might be evidence to link the mechanism of Therapeutic Touch for pain relief to its ability to improve emotional wellbeing. A Cochrane Review from 2009 investigating the benefit of Therapeutic Touch on anxiety was not able to conclude anything, as there have not been any well-designed studies for inclusion in an analysis, indicating the need for high quality research in this area (Robinson et al., 2007).
One area of Therapeutic Touch studies that has come under criticism is the placebo controls used (Rosa et al., 1998). Unusually the emphasis in Therapeutic Touch is that its efficacy is reliant on the intent of the therapist, so the argument is that the result is less likely to be influenced by the belief of the participant. So traditional placebo controls where the subject is not aware whether or not they are receiving the actual treatment would be inadequate without also the provision of treatment by a sham touch practitioner – they imitate the treatment provided by the true touch therapists but do not alter their state of consciousness (So et al., 2008).
While studies which have indicated positive results in relation to pain relief have often been with elderly participants (Lin & Taylor, 1998; Marta et al., 2010; McCormack, 2009), this may bring into question whether the benefits may be seen across other age groups. However, as we now live in a time where the demographics are changing towards an ageing population, with people living longer the incidence of chronic disease increases and with many of these pain can be a factor; finding a treatment which may benefit older adults is particularly important (Marta et al., 2010).
So in answer to the question posed, there is some indication that Therapeutic Touch aids pain relief, at least in certain patient groups. However, further research will be required before firm conclusions can be drawn and before Therapeutic Touch becomes a mainstream therapy.

References:

Fricker, J. (2003) Pain in Europe [PDF] Available at: http://www.britishpainsociety.org/Pain%20in%20Europ%20survey%20report.pdf – accessed on 29th April 2012.
Lin, Y.S. & Taylor, A.G. (1998) Effects of therapeutic touch in reducing pain and
anxiety in an elderly population. Integrative Medicine, 1 (4), 155-62.
Marta, I.E. et al. (2010) The effectiveness of therapeutic touch on pain, depression and sleep in patients with chronic pain: clinical trial. Revista da Escola de Enfermagem da USP, 44 (4), 1100-6.
McCormack, G.L. (2009) Using non-contact therapeutic touch to manage post-surgical pain in the elderly. Occupational Therapy International, 16 (1), 44-56.
Monroe, C.M. (2009) The effects of therapeutic touch on pain. Journal of Holistic Nursing, 27 (2), 85-92.
Robinson, J. et al. (2007) Therapeutic touch for anxiety disorders. Cochrane Database of Systematic Reviews, 18 (3), CD006240.
Rosa, L. et al. (1998) A close look at therapeutic touch. Journal of the American Medical Association, 279 (13), 1005-10.
So, P.S. et al. (2008) Touch therapies for pain relief in adults. Cochrane Database of Systematic Reviews, 8 (4), CD006535.
Ventegodt, S. & Merrick, J. (2005) Clinical holistic medicine: chronic pain in the locomotor system. The Scientific World Journal, 5, 165-72.

 

Does Therapeutic Touch Reduce Pain?

Abstract

Many dismiss Complementary and Alternative Medicines such as Therapeutic Touch due to a lack of physiological data accrued from trials (NCCAM, 2000). Therapeutic Touch is considered by those in the field to provide multidimensional effects, not only physiologically, but in thought, feeling, and also spiritually (Leskowitz, 2011). Conventional Controlled Clinical Trials and Randomised Controlled Trials do not consider these additional dimensions, and consequently the results from Therapeutic Touch trials may be severely limited (Fonnebo et al, 2007). If, however, trials conducted on a multidimensional level were to be considered, the evidence collated would suggest that Therapeutic Touch does reduce pain. Further research into trial methodologies may be required to further support this evidence.

Introduction

Within the approach of Complementary and Alternative Medicine, Therapeutic Touch falls into the domain of energy or biofield therapies. Therapeutic Touch is a technique by which a practitioner’s hands are used to rebalance the energy field of a patient with the objective of encouraging healing (NCCAM, 2000). Widely practised by many professionals in the health care sector including nurses, occupational therapists, and physical therapists, Therapeutic Touch has been used to induce relaxation, as well as to reduce stress, anxiety, and pain (Winstead-Fry & Good, 2009). Conditions and illnesses in which Therapeutic Touch has been used to promote the previous outcomes include: Fibromyalgia Syndrome (Dennison, 2004); chronic pain (Marta et al (2010), Lin (1998); arthritis (Peck (1998), Gordon et al (1998)); cancer (Giasson & Bouchard (1998), Aghabati et al (2010), Kelly et al (2004)); Carpal Tunnel Syndrome (Blankfield et al, 2001); post surgical pain (Frank et al (2007), McCormack (2009)). The success of these applications with regard to pain will be looked at in detail below.

Therapeutic Touch and Pain

Complementary and Alternative Medicine, of which Therapeutic Touch is included, is widely dismissed, due to its subjective nature and unconventionally scientific foundations (NCCAM, 2000). Trials such as those by Frank et al (2007) and Blankfield et al (2001) provide support for these claims as it was found that there was no measured decrease in pain felt by those participants receiving Therapeutic Touch therapy, and that Therapeutic Touch may be dismissed as placebo.

Contrary to this dismissal, (Fonnebo et al, 2007)argues that the conventional approach to achieving acknowledgement in new areas of medical science through controlled randomised trials, generally using a placebo as a control, is not suitable for generating evidence in this area of medicine. In this instance, practises are often simplified causing limitations in data available for collection and analysis, thus restricting any attainable conclusions.

Further to the case of (Fonnebo et al, 2007), Leskowitz (2011) argues that Complementary and Alternative Medicine not only promote physiological benefits, but can provide additional benefits in the form of emotions, thoughts, and also spiritually, all of which are dismissed in conventional medical trials. If trials incorporating these additional dimensions were, however, to be regarded as clear evidence for the case of Complementary and Alternative Medicine and hence Therapeutic Touch, a significant amount of data may be accrued, as shown below.

The following reputable electronic databases were searched to gather information including: The Cochrane Library, PubMed, JStor, Science Direct, and others. Examples of Randomised Controlled Trials, or Controlled Clinical Trials were used to evaluate the effect of Therapeutic Touch on pain. Further to this, trials using pain measurement tools and methods recognised and used in conventional medicine were similarly taken into consideration: visual analogue scales, numerical rating scales, verbal rating scales, McGill Pain Questionnaire, Brief Pain Inventory (Caraceni et al, 2002).

In 2010, Aghabati et al conducted a trial, consisting of 90 cancer patients, to evaluate the effects of Therapeutic Touch on pain. The results of this trial saw a significant reduction in pain of those participants receiving Therapeutic Touch in comparison to those participants in the control group who received customary care. In an equally sized trial of 90 patients experiencing post-surgical pain, McCormack (2009) found that Therapeutic Touch decreased pain in participants more so than in those not receiving Therapeutic Touch.

Two further trials of similar size also concluded a distinctly greater reduction in pain when compared to those in the control group not receiving Therapeutic Touch (Lin (1998), Turner et al 1998). Similarly, in smaller trials, significant improvements were felt as a result of Therapeutic Touch therapy (Dennison (2004), Marta et al (2010), Gordon et al (1998).

In addition to these trials displaying positive reductions in pain as a result of Therapeutic Touch, it can be argued that trials which consider pain on a broader plain may also be considered when evaluating the effects of Therapeutic Touch; for example trials measuring subjective feelings and thoughts associated with a reduction in pain, such as anxiety, tension, well-being, calmness, relaxation, and mood. Trials by Lafreniere et al (1999), Peck (1998), Giasson & Bouchard (1998), and Kelly et al (2004) using multidimensional measurements concluded that that Therapeutic Touch had a marked improvement in these feelings.

Conclusion

The scientific design and consequential limitations of conventional randomised clinical trials have resulted in the dismissal of Complementary and Alternative Medicine such as Therapeutic Touch as an effective treatment in the reduction of pain. However, if other dimensions (emotional, philosophical, and spiritual) were to be taken in to consideration then much more evidence, as the trials above illustrate, could validate the claim that Therapeutic Touch is effective in reducing pain. Therefore, considering the evidence gathered it is concluded that on a multidimensional level, there is sufficient evidence here to suggest that Therapeutic Touch can reduce pain, and that provision in clinical trials is required to further substantiate, or negate these claims.

References

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