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Original article| Volume 26, ISSUE 5, P990-997, November 2003
A phase II trial of reiki for the management of pain in advanced cancer patients
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A PHASE II TRIAL OF REIKI FOR THE MANAGEMENT OF PAIN IN ADVANCED CANCER PATIENTS

 * Karin Olson, RN, PhD
   Karin Olson
   Correspondence
   Address reprint requests to: Karin Olson, RN, PhD, International Institute
   for Qualitative Methodology, 6-10 University Extension Center, 8303 112
   Street, University of Alberta, Edmonton Alberta T6G 2T4, Canada.
   
   Affiliations
   Faculty of Nursing and International Institute for Qualitative Methodology
   (K.O.), University of Alberta; Alberta Cancer Board (J.H.); and Cross Cancer
   Institute (M.M.), Edmonton, Alberta, Canada
   Search for articles by this author
 * John Hanson, MSc
   John Hanson
   
   Affiliations
   Faculty of Nursing and International Institute for Qualitative Methodology
   (K.O.), University of Alberta; Alberta Cancer Board (J.H.); and Cross Cancer
   Institute (M.M.), Edmonton, Alberta, Canada
   Search for articles by this author
 * Mary Michaud, RN
   Mary Michaud
   
   Affiliations
   Faculty of Nursing and International Institute for Qualitative Methodology
   (K.O.), University of Alberta; Alberta Cancer Board (J.H.); and Cross Cancer
   Institute (M.M.), Edmonton, Alberta, Canada
   Search for articles by this author

Open AccessDOI:https://doi.org/10.1016/S0885-3924(03)00334-8
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ABSTRACT

This trial compared pain, quality of life, and analgesic use in a sample of
patients with cancer pain (n = 24) who received either standard opioid
management plus rest (Arm A) or standard opioid management plus Reiki (Arm B).
Participants either rested for 1.5 hr on Days 1 and 4 or received two Reiki
treatments (Days 1 and 4) one hour after their first afternoon analgesic dose.
Visual analogue scale (VAS) pain ratings, blood pressure, heart rate, and
respirations were obtained before and after each treatment/rest period.
Analgesic use and VAS pain scores were reported for 7 days. Quality of life was
assessed on Days 1 and 7. Participants in Arm B experienced improved pain
control on Days 1 and 4 following treatment, compared to Arm A, and improved
quality of life, but no overall reduction in opioid use. Future research will
determine the extent to which the benefits attributed to Reiki in this study may
have been due to touch.


KEYWORDS

 * Quality of life
 * Reiki
 * pain control
 * neoplasms/therapy




INTRODUCTION

The effective management of cancer pain is a common problem in palliative care.
High doses of opioids are often associated with multiple side effects, which are
themselves difficult to manage. Our research group has initiated a series of
studies designed to explore non-pharmacologic adjuvants to opioid therapy, with
the objective of minimizing opioid requirements while improving pain control.
Because no published trials of Reiki existed, a single-arm trial was conducted.
1.
 * Olson K.
 * Hanson J.

Using Reiki to manage pain: a preliminary report.
Cancer Prev Control. 1997; 1: 108-113
 * PubMed
 * Google Scholar

Twenty volunteers experiencing pain for a variety of reasons (e.g., cancer,
arthritis, chronic back problems) were provided with a Reiki treatment by a
certified second-degree Reiki therapist. Pain was measured using both a visual
analogue scale (VAS) and a Likert scale. Measures of pain were obtained
immediately before and after the Reiki treatment. Both measures (VAS and Likert
scale) showed a highly significant improvement in pain control (reduction of
2.25 on the VAS and 1.25 on the Likert Scale) following the Reiki treatment
(P<0.0001 for both scales).
Given those findings, the study described below was designed to compare standard
opioid management plus rest to standard opioid management plus Reiki. Rest was
added to the comparison group because Reiki treatment requires participants to
sit or lie quietly for the duration of the treatment, a period of about 1.5
hours. It was thus important to determine whether the improvement in pain scores
seen in the single arm trial described above may have been attributable to rest
rather than Reiki. The purpose of the study was to determine whether Reiki, when
provided as an adjuvant to standard opioid management of cancer pain, resulted
in better pain control, less analgesic use, and an improved quality of life,
compared to standard opioid therapy plus rest.


METHODS


SAMPLE

Following ethical clearance by university and hospital ethics review committees,
staff on three nursing units (an inpatient palliative unit, a hospice, and an
outpatient symptom management clinic) obtained permission from eligible patients
(fluent in written and spoken English, Folstein mini-mental status exam (MMSE)
of at least 23, never had a Reiki treatment before, had not received
chemotherapy or radiotherapy for the past month, rated their pain at 3 or
greater on a 10-point visual analogue scale (VAS), required 2–5 breakthrough
doses of analgesic in the day prior to recruitment, and currently receiving
palliative care due to advanced cancer) for the investigators to approach them
regarding participation in this trial. Over a two-year period, 24 adults (9 men,
mean age 59.5 years; 15 women, mean age 56 years) provided written consent for
participation in this study.
Initial sample size calculations showed that 100 participants (50 per group)
were required to detect a 20% reduction in VAS pain score. The trial was stopped
after 24 evaluable patients were accrued, however, because of increasing
unwillingness to accept assignment to the group receiving standard opioid
management plus rest and persistent requests for Reiki, despite lack of
documented benefit in this population. Reiki is now offered by volunteers, free
of charge, on the inpatient palliative unit that was the primary recruitment
site for this study.


DATA COLLECTION AND ANALYSIS

After receiving written consent, participants were allocated to either standard
opioid management plus rest (Arm A) or standard opioid management plus Reiki
(Arm B), using a computer-generated random number assignment system. Given the
explicit nature of Reiki, it was not possible to blind either the recipients or
the research nurse who assessed all outcomes regarding treatment allocation.
Nevertheless, neither the research nurse nor the participants knew the group to
which participants would be assigned until after consent was obtained. The
principal investigator and the research nurse regularly discussed the importance
of ensuring that all study participants remained in the treatment group to which
they were allocated for the duration of the study; a review of study records
indicated that group assignment was strictly maintained.
In order to describe the sample more fully and to provide a mechanism for
verifying whether confounding variables were indeed equally distributed between
both groups, a pain assessment of each patient was completed on Day 1 using the
Edmonton Staging System.
2.
 * Bruera E.
 * Macmillan K.
 * Hanson J.
 * et al.

The Edmonton staging system for cancer pain: preliminary report.
Pain. 1989; 37: 203-209
 * Abstract
 * Full Text PDF
 * PubMed
 * Scopus (213)
 * Google Scholar

The Edmonton Staging System (ESS) is a staging tool that was developed to
provide a clinical staging system for cancer pain. This system includes known
prognostic factors for the response to treatment. The ESS is an accurate
predictor of the outcome of pain interventions in patients with cancer pain. It
facilitates collection of information about mechanism of pain, nature of pain,
previous narcotic exposure, cognitive function, psychological distress, opioid
tolerance, and history of alcohol and drug dependence.
A quality-of-life assessment (QOL) was also completed on Day 1. The
quality-of-life measure was a multidimensional tool with physical, social, and
psychological subscales.
3.
 * Padilla G.
 * Present C.
 * Grant M.
 * et al.

Quality of life index for patients with cancer.
Res Nursing Health. 1983; 6: 117-126
 * Crossref
 * PubMed
 * Scopus (247)
 * Google Scholar

The construct validity of this tool was established through factor analysis and
all alpha coefficients were at least 0.65 in studies with cancer patients.
4.
 * Ferrell B.
 * Wisdom C.
 * Wenzl C.

Quality of life as an outcome variable in the management of cancer pain.
Cancer. 1989; 63: 2321-2327
 * Crossref
 * PubMed
 * Scopus (173)
 * Google Scholar

The QOL assessment was completed again on Day 7.
Additional data collected included daily diaries in which participants recorded
their VAS pain score at breakfast, lunch, supper, and bedtime, all analgesic
use, and any other activities undertaken for the purpose of obtaining pain
relief. All analgesics were converted into morphine-equivalent units (MEDD) to
facilitate analysis.
Participants in Arm A rested for 1.5 hr on Days 1 and 4 one hour after their
first afternoon analgesic dose. Participants in Arm B received a Reiki treatment
on Days 1 and 4, 1 hour after their first afternoon analgesic dose. The timing
of the Reiki/rest interventions were chosen to coincide roughly with the point
in time when participants would be expected to begin experiencing some reduction
in their pain due to their recently administered opioid. The research nurse
remained with all participants in both arms of the study for the duration of
their rest period or Reiki treatment. She did not touch the participants in
either group, except as necessary to obtain their blood pressure and heart rate.
The Reiki Master was only present during the Reiki treatments; she only touched
participants as outlined below, during the provision of Reiki treatments.
Proponents of Reiki hypothesize that Reiki re-establishes the energy balance in
areas of the body experiencing disease and discomfort, thus promoting healing,
reducing pain, and increasing quality of life. Although Reiki may be provided
with or without physical contact with the body of a recipient, all participants
in this study received Reiki through physical contact provided by a Reiki Master
trained in the traditional Usui method. The treatment, delivered to 18 specific
areas of the body, began with the participant lying on his or her back. Ten hand
positions were performed on the head and torso. The participant was then asked
to lie on his or her stomach (or on their side if more comfortable), where eight
additional hand positions, covering the back, hip area, and feet, were carried
out. A full treatment took approximately 1.5 hours to complete.
Data collected by the research nurse immediately before and after each Reiki
treatment or rest period included a VAS pain score (“How much pain do you have
now?” rated from no pain [0] to worst possible pain
10.
 * Price D.

Psychological mechanisms of pain and analgesia.
IASP Press, Seattle, WA1999
 * Google Scholar

), blood pressure (lying position using a standard portable blood pressure
cuff), respirations (number of breaths in 10 seconds multiplied by 6), and heart
rate (radial pulse in 10 seconds multiplied by 6).
All analyses were conducted using the SAS statistical program
5.

SAS Release 8.2, SAS Institute Inc., Cary, NC, USA.

 * Google Scholar

by the project biostatistician (J.H.), who was blinded with respect to group
assignment. Changes in “before” and “after” scores in Arms A and B for pain,
blood pressure, heart rate, and respirations on both Days 1 and 4 were compared
using the Kruskal–Wallis test, to allow for the lack of normality. Changes from
Day 1 to Day 7 in Arms A and B on the QOL subscales and in analgesic use were
also compared using the Kruskal–Wallis test.


RESULTS

Seventy-three patients met eligibility criteria. Of these, twenty patients
refused participation, stating they were only interested in participating if
they could receive the Reiki treatments. The remaining 53 patients were
initially accrued, but data files were incomplete in 29 cases (5 deaths, 14
withdrawals by research nurse due to drop in MMSE below 23, 3 withdrawals by
patient due to deterioration in health status, no reason stated for 7 remaining
withdrawals), leaving 24 evaluable participants. A comparison of diagnoses,
source of pain, nature of pain, previous opioid exposure, cognitive function,
psychological distress, opioid tolerance (opioid dose increase per day), and
drug or alcohol dependence across groups using Fisher’s exact test showed no
significant differences between Arms A and B (Table 1).
Table 1Description of Sample

Arm A (Opioid plus rest), n = 13Arm B (Opioid plus Reiki), n = 11Primary
diagnosis Solid tumors118 Hematologic12 Unknown11Source of pain Bone
metastasis54 Neuropathic
pain20 Lymphadenopathy20 Ascites10 Visceral01 Unknown36Nature of
pain Non-incidental99 Incidental42Previous narcotics <60 mg oral
morphine/day83 60 but <300 mg oral morphine/day26 300 mg oral
morphine/day32Cognitive function, MMSE 231311Psychological distress No major
psychological distress107 Major psychological distress34Opioid tolerance, dose
increase <5%/day1311History of alcohol or drug dependence Negative
history107 Positive history34

No significant differences were found between groups on any variables.
 * Open table in a new tab

As can be seen in Table 2, participants who received standard opioid therapy
plus Reiki on Day 1 reported a significant improvement in pain, (P = 0.035) and
a significant drop in diastolic blood pressure (P = 0.005) and pulse
(P = 0.019), compared to participants who received standard opioid therapy plus
rest.
Table 2Pain, Blood Pressure, Heart Rate, and Pulse for Arm A and Arm B on Day 1

Arm A (Opioid plus rest)Arm B (Opioid plus
Reiki)VariableBeforeAfterBeforeAfterKruskal–Wallis Comparing Change in Arm A and
Change in Arm BPain (10 cm VAS)4.54.24.53.3P = 0.035Systolic blood pressure (mm
of mercury)109108121117nsDiastolic blood pressure (mm of
mercury)64657268P = 0.005Heart rate (beats/minute)80807871P = 0.019Respirations
(breaths/minute)18181717ns


 * Open table in a new tab

On Day 4, participants who received standard opioid therapy plus Reiki again
experienced a significant drop in pain (P = 0.002) and their drop in diastolic
blood pressure approached significance (P = 0.082), compared to participants who
received standard opioid therapy plus rest (Table 3).
Table 3Pain, Blood Pressure, Heart Rate, and Pulse for Arm A and Arm B on Day 4

Arm A (Opioid plus rest)Arm B (Opioid plus
Reiki)VariableBeforeAfterBeforeAfterKruskal–Wallis Comparing Change in Arm A and
Change in Arm BPain (10 cm VAS)3.83.73.92.4P = 0.002Systolic blood pressure (mm
of mercury)113112119116nsDiastolic blood pressure (mm of mercury)65657167nsHeart
rate (beats/minute)78777876nsRespirations (breaths/minute)18171716ns


 * Open table in a new tab

Participants who received standard opioid therapy plus Reiki also reported a
significant improvement (P = 0.002) in the psychological component of quality of
life from Day 1 to Day 7, compared to standard opioid therapy plus rest (Table
4).
Table 4Quality of Life Data for Day 1 and Day 7

Arm A (Opioid plus rest)Arm B (Opioid plus Reiki)SubscaleDay 1Day 7Day 1Day
7Kruskal–Wallis Comparing Change in Arm A and Change in Arm BPsychological (10
cm VAS)5.15.15.46.2P = 0.002Social (10 cm VAS)2.82.93.03.0nsPhysical (10 cm
VAS)6.76.77.07.5ns


 * Open table in a new tab

A review of daily pain diaries’ data comparing changes in pain and median
morphine equivalent dose from Day 1 to Day 7 showed no significant differences
between participants who received standard opioid therapy plus rest and those
who received standard opioid therapy plus Reiki (Table 5). The analysis of daily
morphine-equivalent analgesic use was conducted using the median since analgesic
use was not normally distributed.
Table 5Pain Diary Reports of Mean and Median Morphine Equivalent Opioid Doses

Arm A (Opioid plus rest)Arm B (Opioid plus Reiki)DayDaily Pain Diary VAS
ScoresMean/Median Morphine Equivalent Opioid DoseDaily Pain Diary VAS
ScoresMean/Median Morphine Equivalent Opioid DoseDay
1Mean = 4.00Mean = 101.10Mean = 4.58Mean = 168.30Standard
error = 0.39Median = 35.00Standard
error = 0.52Median = 20.00CI = 3.15–4.85Standard
error = 19.34CI = 3.43–5.74Standard
error = 44.81BreakfastMean = 4.02CI = 62.47–139.73Mean = 5.01CI = 77.94–258.66Standard
error = 0.50Standard
error = 0.65CI = 2.94–5.10CI = 3.56–6.46LunchMean = 3.88Mean = 5.30Standard
error = 0.29Standard
error = 0.35CI = 3.24–4.51CI = 4.51–6.09SupperMean = 4.36Mean = 4.14Standard
error = 0.52Standard
error = 0.67CI = 3.22–5.50CI = 2.64–5.64BedtimeMean = 3.74Mean = 3.88Standard
error = 0.54Standard error = 0.63CI = 2.57–4.91CI = 2.47–5.30Day
2Mean = 4.11Mean = 109.20Mean = 4.16Mean = 125.21Standard
error = 0.52Median = 30.00Standard
error = 0.53Median = 20.00CI = 2.98–5.24Standard
error = 20.46CI = 2.96–5.37Standard
error = 39.30BreakfastMean = 4.00CI = 68.41–149.99Mean = 3.82CI = 46.15–204.26Standard
error = 0.54Standard
error = 0.70CI = 2.81–5.19CI = 2.22–5.43LunchMean = 3.98Mean = 4.29Standard
error = 0.58Standard
error = 0.62CI = 2.71–5.24CI = 2.88–5.70SupperMean = 4.40Mean = 3.96Standard
error = 0.57Standard
error = 0.62CI = 3.16–5.64CI = 2.56–5.36BedtimeMean = 4.06Mean = 4.50Standard
error = 0.68Standard error = 0.61CI = 2.57–4.91CI = 3.12–5.88Day
3Mean = 4.42Mean = 109.69Mean = 3.96Mean = 136.37Standard
error = 0.61Median = 30.00Standard
error = 0.55Median = 20.00CI = 3.09–5.75Standard
error = 20.43CI = 2.72–5.21Standard
error = 38.29BreakfastMean = 4.05CI = 68.96–150.42Mean = 3.76CI = 59.46–213.29Standard
error = 0.61Standard
error = 0.70CI = 2.71–5.37CI = 2.17–5.35LunchMean = 4.38Mean = 4.02Standard
error = 0.63Standard
error = 0.61CI = 3.01–5.75CI = 2.65–5.39SupperMean = 4.55Mean = 3.79Standard
error = 0.69Standard
error = 0.55CI = 3.06–6.05CI = 2.54–5.04BedtimeMean = 4.70Mean = 4.28Standard
error = 0.67Standard error = 0.56CI = 3.24–6.16CI = 3.01–5.55Day
4Mean = 4.00Mean = 89.23Mean = 3.37Mean = 151.67Standard
error = 0.52Median = 30.00Standard
error = 0.55Median = 30.00CI = 2.87–5.13Standard
error = 17.38CI = 2.14–4.59Standard
error = 41.34BreakfastMean = 3.37CI = 54.53–123.93Mean = 3.79CI = 68.49–234.84Standard
error = 0.49Standard
error = 0.63CI = 2.30–4.44CI = 2.39–5.20LunchMean = 4.18Mean = 3.34Standard
error = 0.65Standard
error = 0.54CI = 2.77–5.60CI = 2.13–4.54SupperMean = 4.45Mean = 3.03Standard
error = 0.55Standard
error = 0.59CI = 3.25–5.60CI = 1.71–4.34BedtimeMean = 4.00Mean = 3.31Standard
error = 0.55Standard error = 0.61CI = 2.80–5.20CI = 1.94–4.68Day
5Mean = 3.61Mean = 91.01Mean = 3.88Mean = 160.29Standard
error = 0.48Median = 30.00Standard
error = 0.52Median = 30.00CI = 2.55–4.67Standard
error = 17.57CI = 2.72–5.04Standard
error = 40.10BreakfastMean = 3.08CI = 55.93–126.08Mean = 3.51CI = 79.76–240.83Standard
error = 0.41Standard
error = 0.54CI = 2.18–3.97CI = 2.31–4.71LunchMean = 3.69Mean = 3.72Standard
error = 0.62Standard
error = 0.54CI = 2.33–5.05CI = 2.52–4.92SupperMean = 4.00Mean = 4.18Standard
error = 0.59Standard
error = 0.56CI = 2.69–5.31CI = 2.92–5.44BedtimeMean = 3.68Mean = 4.16Standard
error = 0.55Standard error = 0.62CI = 2.47–4.88CI = 2.76–5.56Day
6Mean = 3.57Mean = 83.66Mean = 3.37Mean = 147.66Standard
error = 0.46Median = 30.00Standard
error = 0.53Median = 20.00CI = 2.55–4.59Standard
error = 15.31CI = 2.15–4.58Standard
error = 43.10BreakfastMean = 3.23CI = 53.11–114.21Mean = 3.17CI = 60.81–234.51Standard
error = 0.38Standard
error = 0.52CI = 2.39–4.06CI = 2.00–4.34LunchMean = 3.63Mean = 3.47Standard
error = 0.40Standard
error = 0.58CI = 2.74–4.52CI = 2.16–4.78SupperMean = 3.68Mean = 3.43Standard
error = 0.71Standard
error = 0.56CI = 2.11–5.26CI = 2.16–4.70BedtimeMean = 3.85Mean = 3.39Standard
error = 0.70Standard error = 0.54CI = 2.30–5.40CI = 2.16–4.62Day
7Mean = 3.98Mean = 89.13Mean = 3.57Mean = 155.20Standard
error = 0.56Median = 35.00Standard
error = 0.54Median = 20.00CI = 2.76–5.19Standard
error = 16.39CI = 2.54–4.96Standard
error = 42.41BreakfastMean = 3.58CI = 56.46–121.80Mean = 3.23CI = 69.93–240.48Standard
error = 0.60Standard
error = 0.59CI = 2.26–4.89CI = 1.92–4.53LunchMean = 4.18Mean = 3.67Standard
error = 0.65Standard
error = 0.63CI = 2.78–5.59CI = 2.27–5.08SupperMean = 3.94Mean = 4.12Standard
error = 0.65Standard
error = 0.59CI = 2.51–5.36CI = 2.81–5.43BedtimeMean = 4.20Mean = 3.76Standard
error = 0.62Standard error = 57CI = 2.86–5.54CI = 2.48–5.04


 * Open table in a new tab

Only one participant reported using a non-analgesic medication, a
benzodiazepine, to assist with pain management. Two participants reported using
non-pharmacologic strategies (rest, walking) for managing their pain. Because
the use of non-opioid medications and other non-pharmacologic strategies for
pain management were rarely used, no further analysis was conducted on these
variables.


DISCUSSION

When exploring possible explanations for the results of this study, one must
consider several factors. In this study, the research assistant was present for
the full length of both the Reiki and the rest interventions, but the Reiki
therapist was only present during the Reiki intervention. While both team
members were warm, empathic individuals, it is possible that the absence of the
Reiki therapist in the control setting influenced the results of the study. In
addition, one cannot rule out the possibility of a placebo effect. Other
investigators studying energy therapies addressed this problem by developing
placebo Reiki interventions, which were then administered to a control group.
Mansour et al. were successful in developing a placebo Reiki intervention,
intended for use in the management of anxiety during the administration of
chemotherapy, that was indistinguishable from the perspective of recipients, but
the subsequent outcomes of the treatments were not reported.
6.
 * Mansour A.
 * Beuche M.
 * Laing G.
 * et al.

A study to test the effectiveness of placebo Reiki standardization procedures
developed for a planned Reiki efficacy study.
J Alternative Complementary Med. 1999; 5: 153-164
 * Crossref
 * PubMed
 * Scopus (38)
 * Google Scholar

Critics of placebo-controlled trials suggested that when the placebo is in the
form of a human-to-human interaction, one must always contend with the
possibility that even when the experimental and placebo interventions are
indistinguishable, one may still argue that the results may be confounded by the
intention of the provider. For example, the placebo provider may not “try” as
hard as the person delivering the experimental intervention, or may transmit a
sense of sympathy for the placebo recipients (because they are not receiving the
experimental intervention).
The purpose of including the blood pressure, pulse, and respiration measures in
this trial was to provide some additional evidence, over and above a placebo
effect, for the benefit of Reiki. We reasoned that if pain perception truly
declined following the Reiki treatment, we should also see drops in respiration,
heart rate, and blood pressure. On Day 1, the drop in diastolic blood pressure
and heart rate was significant and a non-significant decline in the systolic
blood pressure was noted. We were surprised to find that on Day 4, despite an
even greater improvement in the pain score, none of the additional measures were
significantly improved although the drop in the diastolic blood pressure was
nearly significant (0.082). We have no explanation for this finding except,
perhaps, the small sample size. The improvement in the psychological dimension
of the quality-of-life tool supports clinical experience and is likely, at least
partly due to an improvement in pain control.
The lack of a significant difference in analgesic use between participants who
received standard opioid therapy plus Reiki and those who received standard
opioid therapy plus rest was, in retrospect, not surprising given the short
study period. A short study period was chosen to increase the chance that study
participants would remain cognitively able to provide the level of information
required in this project, but it was probably not long enough to see a change in
analgesic use, particularly because patients are advised to maintain their
prescribed analgesic dose, even if they are feeling better, until it is changed
by their physician. Many of the participants in this study were very close to
the end of life. In subsequent studies we intend to recruit participants with
longer life expectancies (up to 5–6 months if possible) since these individuals
are often cognitively stable over longer periods of time. In addition, we agree
with others who have recommended the collection of data on other psychological
factors such as depression and anxiety because these factors may interact with
perceptions of pain.
7.
 * Targ E.

Evaluating distant healing: a research review.
Alternative Ther Health Med. 1997; 3: 74-78
 * PubMed
 * Google Scholar

, 
8.
 * Austin J.
 * Harkness E.
 * Ernst E.

The efficacy of “distant healing:” a systematic review of randomized trials.
Ann Intern Med. 2000; 132: 903-910
 * Crossref
 * PubMed
 * Scopus (294)
 * Google Scholar

, 
9.
 * Zimmerman L.
 * Story K.
 * Gaston-Johansson F.
 * et al.

Psychological variables and cancer pain.
Cancer Nursing. 1996; 19: 44-53
 * Crossref
 * PubMed
 * Scopus (46)
 * Google Scholar

We were somewhat surprised, however, to find no significant differences in pain
scores from Day 1 to Day 7 between those who received standard opioid therapy
plus Reiki and those who received standard opioid therapy plus rest. The
interpretation of these findings is compounded by the instability of this
patient population. Nevertheless, based on our limited experience, patients
report that the effect of a Reiki treatment lasts approximately 2–3 days. This
being the case, any benefit of Reiki received on Day 4 would be nearly exhausted
by Day 7, and give rise to the finding of no significant improvement in pain
control.
This study raises the importance of studying the influence of touch in pain
management. Many authors have described the use of touch as a source of comfort
for ill individuals. Because the research assistant deliberately did not touch
patients during the rest intervention, some of the benefit seen in the
experimental arm may have been due to the touch associated with the Reiki
treatment. Would any kind of gentle soothing touch have yielded similar results?
The crossover trial we are planning will help us address this point since the
placebo touch intervention is identical to the touch provided during a Reiki
treatment, with the only difference being that the provider of the placebo touch
has not received Reiki training.
No potential biological mechanisms by which interventions such as Reiki might
work have been reported in the scientific literature. Pain is a complex
phenomenon that extends far beyond its physiologic and sensory components. As
Zimmerman et al. note, nociception, perception, and expression of pain are also
influenced by cognition, behavior, affect, and culture.
8.
 * Austin J.
 * Harkness E.
 * Ernst E.

The efficacy of “distant healing:” a systematic review of randomized trials.
Ann Intern Med. 2000; 132: 903-910
 * Crossref
 * PubMed
 * Scopus (294)
 * Google Scholar

Similarly but in a more detailed fashion, Price systematically reviewed the
interrelations between 3 key dimensions of pain—“sensations whose qualities are
uniquely like those which occur during nociceptive stimulation, meanings of
intrusion or threat to the body or self, and unpleasant emotional feelings
associated with these meanings” (p. 215).
10.
 * Price D.

Psychological mechanisms of pain and analgesia.
IASP Press, Seattle, WA1999
 * Google Scholar

It is too early in our work to offer hypotheses about the process by which Reiki
may have an impact on the experience of pain.
As this project drew to a close, the research team considered the possibility of
developing a placebo Reiki intervention as outlined by others
5.

SAS Release 8.2, SAS Institute Inc., Cary, NC, USA.

 * Google Scholar

for the next project. The final decision in this regard was influenced heavily
by the fact that future study participants will have advanced cancer and be
receiving palliative care. As reported by others,
11.
 * Kelner M.
 * Wellman B.

Health care and the consumer choice: medical and alternative therapies.
Soc Sci Med. 1997; 45: 203-212
 * Crossref
 * PubMed
 * Scopus (262)
 * Google Scholar

these participants want to “try” anything that might provide relief from their
distress. Recruitment in this study was difficult owing to patients’ reluctance
to be in the group receiving standard opioid management plus rest, given their
significant pain control problems and the approach of the end of their life. For
these reasons, the study team is currently designing a 4-arm crossover trial of
standard care alone, standard care plus Reiki, standard care plus placebo touch,
and standard care plus rest. This trial will help us distinguish benefits of
Reiki from those of touch, controlling for any benefits associated with rest.
The findings of this study should be generalized cautiously, given the small
sample size, and limitations described above. Regardless of whether the addition
of non-pharmacologic adjuvants reduce opioid use or not, this small study lends
support to the hypothesis that Reiki, when used in conjunction with standard
opioid pain management strategies, relieves pain and improves quality of life.
Future studies will show whether this improvement is attributable to touch alone
or to touch as a part of a Reiki treatment.


ACKNOWLEDGEMENTS

The authors acknowledge Reiki Master Lisa Fontanella, who provided all the Reiki
treatments in this study, and Dawn Stuckless, who collected the data. This study
was funded by the Alternative Cancer Research Foundation in Calgary, Alberta.



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     IASP Press, Seattle, WA1999
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ARTICLE INFO


PUBLICATION HISTORY

Accepted: March 14, 2003


IDENTIFICATION

DOI: https://doi.org/10.1016/S0885-3924(03)00334-8


COPYRIGHT

© 2003 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc.


SCIENCEDIRECT

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TABLES

 * Table 1Description of Sample
 * Table 2Pain, Blood Pressure, Heart Rate, and Pulse for Arm A and Arm B on Day
   1
 * Table 3Pain, Blood Pressure, Heart Rate, and Pulse for Arm A and Arm B on Day
   4
 * Table 4Quality of Life Data for Day 1 and Day 7
 * Table 5Pain Diary Reports of Mean and Median Morphine Equivalent Opioid Doses


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