Feature ArticleThe effect of healing touch on the pain and mobility of persons with osteoarthritis: A feasibility study
Introduction
Osteoarthritis (OA), the most common joint disorder and one of the main causes of chronic disability in the elderly,1, 2, 3 affects approximately 27 million Americans.4 Half of all adults will develop symptomatic OA of the knee at some point in their lives.5 Joint pain, the most common symptom of OA, is characteristically a dull, aching, chronic sensation that is exacerbated by activity.5 The most distressing feature of this symptom, other than the pain itself, is its impact on mobility, independence, and life quality.6, 7, 8, 9 OA is not simply a degenerative joint disease, but rather is an abnormal remodeling of joint tissue driven by a host of inflammatory mediators within the affected joint. Joint changes include degradation of the articular cartilage, thickening of the subchondral bone, formation of osteophytes, variable degrees of inflammation of the synovium, degeneration of ligaments and, in the knee, the menisci, and hypertrophy of the joint capsule.3 The hands, which are the most prevalent location of OA, are least likely to be symptomatic. The knee and hip, the second and third most common location, are frequently symptomatic.3, 10, 11, 12 Since there is no known cure for OA, treatment remains limited to symptomatic relief and, ultimately, to joint replacement.5, 13
Because the mechanisms of OA are multifactorial, no single regimen is equally effective for all.5 Pharmacological approaches have significant drawbacks. Agents used to treat chronic OA pain (a) are often ineffective,14 (b) can produce renal and liver damage when used over the long term,15 (c) can have adverse gastrointestinal side effects,16 and (d) among elderly who commonly receive multiple prescription drugs, there is a high risk of adverse drug interactions.17, 18
Current National Institute for Clinical Excellence guidelines for OA identifies several core self-management recommendations regarding exercise, local strengthening activities, and weight loss if overweight.19 Research has highlighted potential gains from exercise and life style changes.20, 21, 22, 23, 24 Recent meta-analyses of the use of physical activity interventions (exercise, physical activity, physical fitness, exertion, exercise therapy, physical education and training, and walking) by persons with OA have found moderate positive effects on physical activity, but only small positive effects on pain and physical function. Sustaining an exercise regimen was often negatively affected by the pain and stiffness precipitated by the activity.25, 26
More than half of all adults with diabetes or heart disease also have arthritis, most often OA. While physical activity is a crucial element for managing these chronic conditions, OA pain often inhibits mobility.13 Immobility has consistently been among the risk factors related to falls in the elderly within the community, acute care settings, and long-term care settings.27 Thus, interventions that reduce or prevent OA-associated pain and lack of mobility are likely also to improve safety and the outcomes of co-morbid chronic diseases.
Non-pharmacologic, noninvasive interventions have been used with OA to lessen pain, improve physical function, and increase a sense of control and independence. Some of these interventions include: exercise, rest and joint protection, massage, thermal application, hydrotherapy, cognitive-behavioral techniques, nutrition, herbs and natural products such as glucosamine and chondroitin and alternative modalities such as Therapeutic Touch (TT), acupuncture, biofeedback, hypnotherapy, Tai Chi, and yoga.28, 29, 30, 31, 32, 33
Research regarding the use of Therapeutic Touch (TT), a biofield therapy, with non-institutionalized persons with OA has demonstrated significant reduction in pain and distress and improved function after 6 weekly TT sessions.34, 35 A more recent study of TT among non-institutionalized persons with OA increased TT sessions to twice a week over 8 weeks. A significant difference was found between the treated and the control group regarding physical function with all three of the different function tests used. However, only one of three subjective surveys found a difference regarding pain level.36 Peck35, 37 noted that elders with OA needed at least three to four TT sessions before a clinically significant change in pain and function was noted.
The noninvasive modality of Healing Touch (HT) is a nursing therapeutic that is considered a complementary therapy.38 HT is also categorized by the National Center for Complementary and Alternative Modalities (NCCAM) as one of the biofield modalities.39 While both TT and HT are biofield modalities the two use different techniques to deliver their work. HT, as used here, refers to the techniques taught in the standardized curriculum of Healing Touch International, which is endorsed by the American Holistic Nurses Association.40 HT is supported by Roger's holistic nursing theory.41 This theory states that all persons are highly complex fields of various forms of life energy. The system is open so the fields of energy are in constant interaction and exchange with surrounding energy fields thereby changing each other. HT techniques, of which there are over 30, do not utilize body manipulation, such as chiropractic does, nor tissue work like massage. With all techniques, the HT practitioner uses a conscious, intentional process of directing energy through their hands to the patient either by contacting the patient's energy field close to the body and/or lightly touching the body. The goal is to clear, energize and balance the patient's energy field enabling access to their innate healing ability.42 Currently more than 30,000 nurses use this modality in health care settings to reduce pain and anxiety, assist with wound and fracture healing, reduce the side effects of chemotherapy and radiation, normalize blood pressure, and support feelings of well-being.40
Reports from practitioners indicate that HT accelerates wound healing, relieves pain, reduces anxiety, and enhances relaxation.42 Research findings, although limited, have noted that HT significantly reduces pain, distress, and fatigue43; improves quality of life, emotional role functioning and mental health44; improves mood, relaxation and pain relief45; and preserves natural killer cell activity, and reduces depression.46
Effects of biofield therapies on disease processes are hypothesized to occur via a variety of pathways, both direct and indirect. HT evokes the parasympathetic response inducing relaxation, resulting in blunting of the neuroendocrine stress hormone responses.47, 48, 49, 50 It has also been postulated that biofield therapies influence the neuroplasticity of the brain to create a repatterning as the neuromatrix may be modified by various sensory inputs.51 It has been suggested that HT may be able to influence one or more of these pathways.52
More direct mechanisms would include pathways not mediated by the neuroendocrine stress response. For example, pain has been characterized as disruptive to the body's harmony or balance53 and biofield therapies are thought to release blocks to circulation of “vital energy” within the patient.54 Modulation of a person's energy which recreates flow and balances throughout the body is thought to affect multiple systems, and ultimately supports greater resistance to disease and more rapid recovery. These direct and indirect mechanisms may also work together.54
The aim of this pilot study was to investigate the effects of Healing Touch (HT) on the pain level, joint function, mobility, and depression in persons with osteoarthritis of the knee joint(s).
Section snippets
Method
A randomized controlled trial with a repeated measure design was used. Cognitively intact, persons (institutionalized [n = 14] and community dwelling [n = 5]) with a diagnosis of OA of the knee joint(s) were assigned by chance (coin toss) to either the intervention or the FV comparison group. Due the nature of the treatments (HT & FV) and disclosure of the purpose of the study the subjects were not blinded to which treatment they received. HT sessions were received three times per week for
Subject characteristics
The subjects were predominately female Caucasians, between the ages of 62 and 99. The majority resided in care agencies, had a cardiovascular co-morbidity, and used Tylenol for pain control. Four persons (two in each group) also used an opioid in addition to Tylenol for pain control. The two groups were similar regarding the demographic variables of age, sex, ethnicity, type of residence, number of knees affected, type of co-morbidity and pain medications used (see Table 3). Table 2 describes
Discussion
Key findings of this pilot study were that HT was able to effect significant reductions in pain severity and pain interference with life activities in osteoarthritis patients as compared to a “friendly visit” group in which such changes were not observed. Accompanying the reduction in pain, joint function of the knees improved within the HT group over time. The HT group demonstrated significant within group changes in 10 of the 12 measures (84%) while none of the 12 variables showed significant
Limitations
The small sample size of this study, and the small number of males, and inclusion of only Caucasians limits the generalizability of these findings. However, it is remarkable that, with this very small sample size, any significant findings occurred. In addition, the Cohen's d levels indicate that these findings provide moderate to strong effect size measures (66% were over the 0.5 level). Due the nature of the treatments (HT & FV), and the disclosure of the purpose of the study, the subjects
Significance
Despite the growing concern regarding the increasing numbers of persons with OA, predicted to double by 2020, due in large part to the exploding prevalence of obesity and the graying of the “baby boomers”, there remain few safe and effective interventions.70 The first two of the twenty five OA management recommendations by the Osteoarthritis Research Society International are: first use a combination of modalities and second, provide information about the importance of changes in lifestyles
Acknowledgments
The authors wish to thank the generous support from the Hartford Center for Geriatric Nursing Excellence and the John A. Hartford Foundation [PI: Janet Specht, PhD, RN, FAAN, the University of Iowa College of Nursing]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the John A. Hartford Foundation. We also are grateful for the support from Ms. Maria Hein for her database management support, and Ms. Hyunkyoung Oh for her support in
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Effects of Therapeutic Touch on Healing of the Skin in Rats
2017, ExploreCitation Excerpt :The Krieger–Kunz method was then developed, which involves four steps for TT: (a) centralization of consciousness, (B) EF evaluation, (C) rebalancing or resynchronization of EF, (D) the EF reassessment.11 Among complementary treatments, TT has attracted the interest of the scientific community in the last decades because of its potential effects on several experimental and clinical conditions, especially in relation to fibroblast proliferation,13 inflammatory response,14 acceleration of healing response,15 effects on pain thresholds,14,16,17 and increased hematocrit and hemoglobin levels.18 However, its use in the treatment for skin healing has not been well understood until now, and there is no strong evidence to support its use in clinical practice,19 which reinforces the need for developing animal model experimental studies, followed by clinical trials.
Integrative Medicine for the Treatment of Persistent Pain
2017, Primary Care - Clinics in Office PracticeCitation Excerpt :There is ongoing interest in further research investigating the use of these modalities for musculoskeletal concerns. A pilot study examining the impact of healing touch on pain and mobility in those with osteoarthritis demonstrated significant improvements in both pain intensity and life interference,64 whereas another study showed improvements in shoulder range of motion.65 Biofield modalities may hold promise as adjunctive treatments for pain.
Is energy healing an effective non-pharmacological therapy for improving symptom management of chronic illnesses? A systematic review
2016, Complementary Therapies in Clinical PracticeCitation Excerpt :A further seven studies maintained the same healer(s) for all sessions however results of these studies were not significant [13,27,33,40,46,47,50,55]. Eleven out of 13 energy healing interventions with significant results involved large groups with greater than five participants allocated per healer [12,29,31,32,35,37,39,43,45,49,53,56]. Laying of hands either on or a few inches above the body was utilised in 22 out of the 26 included studies, of which twelve studies generated significant results [12,28,29,31,32,37–39,43,45,48,49].
The clinical effectiveness of cognitive behavior therapy and an alternative medicine approach in reducing symptoms of depression in adolescents
2016, Psychiatry ResearchCitation Excerpt :There are many factors that might be contributing to the effectiveness of this approach including belief to this method and trust to the practitioner (Van Aken and Taylor, 2010). Reiki therapy has been mostly studied in patients with cancer for reducing pain, depression, and anxiety (Fleisher et al., 2014) and other disease where patients experience pains and depression such as osteoarthritis (Lu et al., 2013). There are mixed results for the effectiveness of this approach in treating symptoms of disease across different studies, with some studies not supporting a vigorous effect of this therapy in reducing pain, anxiety, and depression (Lee et al., 2008; Thrane and Cohen, 2014).