Abstract
Background: Pain is a common and significant symptom in many individuals with multiple sclerosis (MS). The presence and severity of pain in individuals with MS has also been shown to be associated with higher levels of depression, functional impairment, and fatigue. It is common for MS patients and their caregivers to worry about narcotic addiction in the management of chronic pain. Therefore, this study aimed to determine and compare the effects of reflexology and relaxation on pain in women suffering from MS.
Methods: This study was a single-blind randomized clinical trial performed on 75 patients with MS referred to the MS Clinic of Ayatollah Kashani Hospital (Isfahan, Iran). After simple non-random sampling, using the minimization method, participants were randomly assigned to the three groups of reflexology, relaxation, and control. In the experimental groups, foot reflexology and relaxation interventions (Jacobson and Benson) were performed within 4 weeks, twice a week for 40 min. The control group received routine care and medical treatment as directed by a doctor. Data were collected using the Numerical Rating Scale before, immediately after, and 2 months after interventions in all three groups. Data analysis was performed using SPSS version 18 and descriptive and inferential statistical tests.
Results: Findings obtained from analysis of variance (ANOVA) showed no significant differences between mean pain intensity scores in the three groups preintervention and 2 months after interventions (p > 0.05). However, this difference was statistically significant immediately after the study (p < 0.05). Findings obtained from repeated measures ANOVA showed that the severity of pain significantly differed during different times in reflexology and relaxation (p < 0.05); however, this difference was not significant in the control group (p > 0.05). Furthermore, Fisher’s least significant difference (LSD) revealed a significantly higher reduction in pain intensity scores in the reflexology group after the intervention, compared with the two other groups, but showed no significant differences between relaxation and control groups. There were no significant differences between the three groups 2 months after the interventions (p > 0.05).
Conclusions: The results showed that both interventions are effective on relieving pain in women with MS; however, it appears that the effect of reflexology on pain reduction is greater than that of relaxation. Hence, these two methods can be recommended as effective techniques.
Acknowledgments
The authors would like to thank all patients who participated in the study despite their health conditions and all those who contributed to the study.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This research was conducted under financial support of the Vice Chancellor for Research of Isfahan University of Medical Sciences 392094 approved by Isfahan University of Medical Sciences.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Milo R, Kahana E. Multiple sclerosis: geoepidemiology, genetics and the environment. Autoimmun Rev 2010;9:387–94.10.1016/j.autrev.2009.11.010Search in Google Scholar
2. Shilling Mccann JA. Women’s health. A guide to health promotion and disorder management. Philadelphia: Lippincott Williams &Wilkins, 2005.Search in Google Scholar
3. Barker E. Neuroscience nursing: a spectrum of care, 3rd ed. USA: Mosby Elsevier, 2008.Search in Google Scholar
4. Etemadifar M, Sajjadi S, Nasr Z, Firoozeei TS, Abtahi SH, Akbari M, et al. Epidemiology of multiple sclerosis in Iran: a systematic review. Eur Neurol 2013;70:356–63.10.1159/000355140Search in Google Scholar
5. Ziemssen T. Symptom management in patients with multiple sclerosis. J Neurol Sci 2011;311:S48–52.10.1016/S0022-510X(11)70009-0Search in Google Scholar
6. Shaygannejad V, Sadramely SM. Successful living with MS (multiple sclerosis). One version. Mashhad: Vazhyran Publications, 2010 [in Persian].Search in Google Scholar
7. Madell R. Common MS symptoms in women, 2013. Available at: http://www.healthline.com/health/multiple-sclerosis. Accessed:13 Feb 2014.Search in Google Scholar
8. Varlow M. Managing pain for people living with MS. Blackburn, Vic: MS Australia – ACT/NSW/VIC, 2010. Available at: http://www.msaustralia.org.au/documents/managing-pain/ManagingPain_Web.pdf. Accessed:13 Apr 2014.Search in Google Scholar
9. Jensen MP, Barber J, Romano JM, Molton IR, Raichle KA, Osborne TL, et al. A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain. Int J Clin Exp Hypn 2009;57:198–221.10.1080/00207140802665476Search in Google Scholar PubMed PubMed Central
10. O’Connor A, Schwid SR, Herrmann DN, Markman JD, Dworkin RH. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain 2008;137:96–111.10.1016/j.pain.2007.08.024Search in Google Scholar PubMed
11. Atashzadeshorideh F, Mohamadi SH. Comparison of the effects of aromatherapy and massage on pain multiple sclerosis patients. J of Shahid Beheshti School of Nurs & Midwifery 2007;16:28–32 [in Persian].Search in Google Scholar
12. Dougherty P, Lawrence D. Chiropractic management of musculoskeletal pain in the multiple sclerosis patient. Clin Chiropract 2005;8:57–65.10.1016/j.clch.2005.03.004Search in Google Scholar
13. Castro-Sanchez AM, Mataran-Penarrochoa GA, Lara-Palomo I, Saavedra-Hern´andez M, Arroyo-Morales M, Moreno-Lorenzo C. Hydrotherapy for the treatment of pain in people with multiple sclerosis: a randomized controlled trial. Evid Based Complement Altern Med 2012;2012:1.10.1155/2012/473963Search in Google Scholar PubMed PubMed Central
14. Shamsardakani M, Ardeshirrohanifard SH, Abedtabesh H. Take on the application and use of complementary and alternative medicine in other countries, according to the latest statistical studies. J Tradit Med Islam Iran 2011;2:37–45 [in Persian].Search in Google Scholar
15. Esmonde L, Long AF. Complementary therapy use by persons with multiple sclerosis: benefits and research priorities. Complement Ther Clin Pract 2008;14:176–84.10.1016/j.ctcp.2008.03.001Search in Google Scholar PubMed
16. Wang MY, Tsai PS, Lee PH, Chang WY, Yang CM. The efficacy of reflexology: systematic review. J Adv Nurs 2008;62:512–20.10.1111/j.1365-2648.2008.04606.xSearch in Google Scholar PubMed
17. Valiani M, Amirkhani A. Stress Management skills, 1st ed. Esfahan: Ala publications, 2009 [Persian].Search in Google Scholar
18. Hamidizadeh S, Ahmadi F. Asghari M. Reviewing the relaxation techniques on anxiety and stress of elderly patients with hypertension. J of Shahrekord University of Medical Sciences 2006;8:45–51 [in Persian].Search in Google Scholar
19. Mokhtarinouri J, Siratinir M. Comparison the effects of reflexology and Benson relaxation on pain after cesarean. J Health Sci Res Institut Jahad 2010;9:289–98 [in Persian].Search in Google Scholar
20. Salehi M, Shariati A, Ansari M, Latifi M. Effect of Benson relaxation intervention on symptom scales quality of life (QOL) in breast cancer patients undergoing chemotherapy. Jundishapur J Chronic Dis Care 2012;1:1–8 [in Persian].Search in Google Scholar
21. Tiran D, Sue M. Complementary therapies for pregnancy and childbirth. New York: Bailliére Tindall, 2000. Translated by Mohamad Ali Raghaie, Ataallah Ghahiri. Isfahan: Kankash Publication, 2002 [in Persian].Search in Google Scholar
22. Saghaei M. An overview of randomization and minimization programs for randomized clinical trials. J Med Signals Sens 2011;1:55–61.10.4103/2228-7477.83520Search in Google Scholar
23. Tiran D. Reflexology in pregnancy and childbirth. USA, New York: Churchill Livingstone Elsevier, 2010.Search in Google Scholar
24. Field T, Hernandez-Reifa M, Diegoa M, Fraserc M. Lower back pain and sleep disturbance are reduced following massage therapy. J Bodyw Mov Ther 2007;11:141–5.10.1016/j.jbmt.2006.03.001Search in Google Scholar
25. Lee J, Han M, Chung Y, Kim J, Choi J. Effects of foot reflexology on fatigue, sleep and pain: a systematic review and meta-analysis. J Korean Acad Nurs 2011;6:821–33.10.4040/jkan.2011.41.6.821Search in Google Scholar PubMed
26. Poole H, Glenn S, Murphy P. A randomised controlled study of reflexology for the management of chronic low back pain. Eur J Pain 2007;11:878–87.10.1016/j.ejpain.2007.01.006Search in Google Scholar PubMed
27. Nahavandinezhad S. Scientific methods of massage therapy, 1st ed. Isfahan: Isfahan University of Medical Sciences Publication, 1385 [in Persian].Search in Google Scholar
28. Eghbali M, Safari R, Nazari F, Abdoli S. The effects of reflexology on chronic low back pain intensity in nurses employed in hospitals affiliated with Isfahan University of medical sciences. Iran J Nurs Midwifery Res 2012;17:239–43.Search in Google Scholar
29. Siev-Ner I, Gamus D, Lerner-Geva L, Achiron A. Reflexology treatment relieves symptoms of multiple sclerosis: a randomized controlled study. Mult Scler 2003;9:356–61.10.1111/j.2042-7166.1997.tb00739.xSearch in Google Scholar
30. Joyce M, Richardson R. Reflexology can help MS. Int J Altern Complement Med 1997;15:10–12.Search in Google Scholar
31. Movaghar MH, Hashemi Javaheri AA, Atri AE. The effect of foot reflexology on the reduction of chronic low back pain of chronic low back pain. Iran J Health Phys Activ 2012;3:14–18.Search in Google Scholar
32. Sadeghi Shermeh M, Bozorgzad P, Ghafourian AR, Ebadi A, Razmjoei N, Afzali M, et al. Effect of foot reflexology on sternotomy pain after coronary artery bypass graft surgery. Iran J Critic Care Nurs 2009;2:51–4.Search in Google Scholar
33. Mackereth PA, Booth K, Hillier VF, Caress AL. Reflexology and progressive muscle relaxation training for people with multiple sclerosis: a crossover trial. Complement Ther Clin Pract 2009;15:14–21.10.1016/j.ctcp.2008.07.002Search in Google Scholar PubMed
34. Hughes CM, Smyth S, Lowe-Strong AS. Reflexology for the treatment of pain in people with multiple sclerosis: a double-blind randomised sham-controlled clinical trial. Mult Scler 2009;15:1329–38.10.1177/1352458509345916Search in Google Scholar PubMed
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