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Reflexology treatment relieves symptoms of multiple sclerosis: A randomized controlled study


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To evaluate the effect of reflexology on symptoms of multiple sclerosis (MS) in a randomized, sham-controlled clinical trial. Seventy-one MS patients were randomized to either study or control group, to receive an 11-week treatment. Reflexology treatment included manual pressure on specific points in the feet and massage of the calf area. The control group received nonspecific massage of the calf area. The intensity of paresthesias, urinary symptoms, muscle strength and spasticity was assessed in a masked fashion at the beginning of the study, after 1.5 months of treatment, end of study and at three months of follow-up. Fifty-three patients completed this study. Significant improvement in the differences in mean scores of paresthesias (P = 0.01), urinary symptoms (P = 0.03) and spasticity (P = 0.03) was detected in the reflexology group. Improvement with borderline significance was observed in the differences in mean scores of muscle strength between the reflexology group and the controls (P = 0.06). The improvement in the intensity of paresthesias remained significant at three months of follow-up (P = 0.04). Specific reflexology treatment was of benefit in alleviating motor; sensory and urinary symptoms in MS patients.
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Re exology treatment relieves symptoms of multiple sclerosis: a
randomized controlled study
I Siev-Ner
, D Gamus
*, L Lerner-Geva
and A Achiron
Complementary Medicine Clinic, Department of Orthopedic Rehabilitation;
Gertner Institute for Epidemiology and
Health Policy Research;
Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, I srael
Objective: To evaluate the effect of refle xol o gy on symptoms o f multiple sclerosis (MS) in a randomized, sham-contro ll ed clinical trial.
Methods: Seventy-one MS patients w ere randomized to either study or contro l group, to receive an 11-week treatment. Reflexology
treatment included manual pressure on specific points in the feet and m assage of the calf area. The co ntro l gro up received nonspecific
massage of the calf area. The intensity of paresthesi as, urinary symptoms, muscle strength and spasticity was assessed in a masked fashion
at the beginning o f the study, after 1.5 months of treatment, end of study and at three months of follow-up. Results: Fifty-three patients
completed this study. Significant impro vement in the differences in mean scores of paresthesias (P
0.01), urinar y symptoms (P
and spasticity (P
0.03) was detected in the re flexology gro up. Improvem ent wit h bo rder line significance was observed in the d ifferences
in mean scores of muscle stre ngth between the reflexo logy group and the contro ls (P
0.06). The improvement in the intensity of
paresthesias remained significant at three months o f follow-u p (P
0.04). Conclusions: Specific reflexology treatment was o f benefit i n
alleviating motor, senso ry and urinar y symptoms in MS patients
Multiple Sclerosis
(2003) 9,
Key words:
co mplementary medicine; multiple sclero sis; pare sthesia; re exo logy; spasticity
Introductio n
Multiple sclerosis (MS) is the commonest human demye-
linating disease with a general prevalence rate of 50
per 100 000 population in northern Anglo-Saxon commu-
nities. This autoimmune disorder is characterized by
repeated occurrence of de myelinating lesions within the
central nervous system and, similarly to other chronic
illnesses, can profoundly affect qualit y of life and activ-
ities of daily living. Among major symptoms caused by
MS are spasticity, paresthesias and bladder dys-
Medical treatment of MS patients has em-
phasized both pharmacological and rehabilitation
New pharmacotherapeutic a gents are targeted mainly to
reduce demyelination by modifying the immune response
(beta interferons), to enhance remyelination (growth fac-
tors) and to improve conduction in demyelinated fibres.
Unfortunately, some current and investigational therapies
are associated with considerable adverse effects, or are of
limited efficacy.
MS patients, similarly to patients with other chronic
diseases, frequently apply to complementary (‘alterna-
tive’) therapies,
yet the data concerning their effective-
ness, safety or costs is limited.
Reflexology is also known as ‘zone ther apy’ and in-
volves manual stimulation of reflex points on the feet that
correspond somatotopicall y to specific areas and organs of
the body. It is based on the theory that all organs are
represented by various points on the feet, forming a map of
the whole body, and that massaging specific areas of feet
can affect corresponding target organs. Although the
technique was already well known to ancient Chinese
physicians, it was introduced to the west by Dr W
Fitzgerald in 1913. Since then, reflexology be came one
of the most popular treatment modalities in complemen-
tary medicine.
However, only one randomized con-
trolled study was performed until now, demonstrating that
specific reflexology treatment is superior to nonspecific
massage in treating symptoms of premenstrual syn-
Our clinical experience indicated that paresthesias and
spasticity in MS and in patients with other disorder s
could be alleviated by reflexology.
We therefore designed a prospect ive, randomized,
sham-controlled clinical trial to compare the effect of
reflexolog y treatment versus non-specific massage on MS
patients with spasticity, sensory and urinary symptoms.
Meth o d s
Planned study population
All patients who were treated at the MS Center, Sheba
Medical Center, Tel Hashomer, Israel.
*Correspondence: Dorit Gamus, Complementary Medicine
Clinic, Department of Orthopedic Rehabilitation, Sheba
Medical Center, Tel-Hashomer, 52621, Israel.
Received 23 November 2002; revised 24 March 2003;
accepted 25 March 2003
Multiple Sclerosis 2003; 9: 356¡/361
Arnold 2003
Inclusion criteria Patients with a definite diagnosis of MS,
suffering from paresthesias and/or spasticit y, or both.
Exclusion criteria Exc lusion criteria were:
. acute relapse of the disea se three months preceding or
during the st udy period;
. recent onset or discontinuation (less than one month)
of physiothe rapy or any other manual treatment (e.g.,
massage therapy).
This criterion was applied in order to eliminate change s
in the muscle tone unrelated to reflexology treatment or to
the basic disease.
For the same reason, patient s were required to report
about any change in their medical treatment during the
Protoco l
Planned interventions
Patients were randomized by block randomization. Every
patient that was found to be eligible to the study was
assigned a s ealed envelope with the group allocation
(study/control). Each patient received 11 weeks of treat-
ment once a week, for 45 minutes. The study was
performed at the Clinic of Complementary Medicine,
Sheba Medical Center, Tel-Hashomer, Israel, with the
participation of 36 reflexologists. Each reflexologist trea-
ted one study and one control patient. Patients in the
study group received full reflexology treatment which
included manual pressure on specific points of foot soles
and massage of the calf area, while patients in the control
group re ceived sham treatment of nonspecific massage of
the calf, providing control for touch therapy and general
relaxation. The patients in both groups were therefore
exposed to the same therapists. All patients received e qual
number and duration of treatment sessions. The treatment
protocol was designed and supervised by two senior
reflexolog ists.
Patients were informed that they are going to receive
reflexolog y treatment targeted mainly either to the sole
(study) or to the ca lf area (control s), while the efficacy of
each is yet to be determined. The reflexololgists were
instructed not to discuss the efficacy of eit her treatment
with the patients.
Clinical assessment was performed in a masked fashion
before, at the onset, after six weeks of treatment, upon
completion of the treatment period and after additional
three months.
O utcome measures
a) The intensity of pa resthesias was assessed by the
Visual Analogue Scale (VAS). As the majority of the
patients suffered from paresthesias in several loca-
tions, the intensity, location and duration (hours/
week) of each paresthesia were recorded. Evaluation
of VAS at eac h time point of the follow- up included
the information concerning the loc ations reported
prior to the commencement of the trial, as well as
inquiry about appearance of additional locations. An
average was taken for each patient’s scores a t each
time point of the study. This approach was applied in
order to avoid an overl oad of information.
b) Urinary symptoms were not a part of primary inclu-
sion criteria, but were assessed in all patients by the
American Urological Association ( AUA) symptom
c) Proximal lower extremities muscles (iliopsoas, quad-
riceps, hamstrings and adductor muscles) of the
patients were eval uated as follows: muscle tone-by
Ashworth score, and muscle strength-by British
Medical Research Council (BMRC) scale.
The eva-
luations were performed by the same physiotherapist
in a masked fashion, under supervision of a senior
neurologist. Since the same muscle groups were
measured in all patients, we evaluated an average
score for each patient at each time point of the study.
Sample size calc ulation
In orde r to evaluate the possible effect of reflexology
treatment on MS patients (which was not yet reported) an
open trial was conducted.
Twenty MS patients suffering from paresthesias were
recruited and trea ted for a period of 1.5 months. The
intensity of paresthesias was evaluated prior to treatment
and at the end of the treatment period. An improvement
was note d in seven of 20 patients.
Sample size for the current clinical trial was calculated
based on expected improvement of 30% exposed to
reflexolog y treatment and 5% among the controls. A ratio
of 1:1 (exposed: controls) was chosen with a
0.05 and 1-
The study population was calculated as 70
patients, equall y allocated to treatment and control
Data analysis
Statistical analysis was performed using SPSS-PC soft-
ware for windows (Version 8.0, SPSS, Chicago, 1997).
Probability of B
0.05 was considered statistically signifi-
cant. Due to the small number of observations in both the
study and control groups, normal distribution was not
evident. Therefore, nonparametric analysis was per-
Two related samples Wilcoxon signed Ranks test was
performed to calculate for significanc e of differences
within the study and the control groups at various time
points of the trial. Mann
Whitney U-test for two inde-
pendent samples was performed for the significance of
differences between the study and the control groups.
Trends over time were eva luated betwee n the differ-
ences from base line values at six weeks following com-
mencement of the trial, at completion of the trial and at
three months of follow-up.
Only patients who completed the trial were analysed.
The local ethical committ ee and Israeli Ministry of
Health approved t he study and written informed consent
was obta ined from all patients.
Reflexology in treatment of multiple sclerosis
I Siev-Ner et al.
Multiple Sclerosis
Out of 71 patients recruited, 53 (75%) completed this
study: 27 patients in the study and 26 in the control group.
The demographic variables of the patients are demon-
strated in Table 1. There was no statistically significant
difference between the study a nd the control group in any
of the fol lowing parameters: age, sex, duration of the
disease, or in the initi al severity of the evaluated symp-
There were no statistically significant differences be-
tween the intention-to-treat patients and the completers,
as well as between the dropouts and the c ompleters.
The outcome measures of clinical symptoms: (I) mean
intensity of parasthesias, evaluated by VAS score; (II)
urinary symptoms, evaluated by AUA scale; (III) muscle
strength, presented as sum of proximal muscle group on
BMRC scale, and (IV) spastisity, assessed by Ashworth
scale, are pre sented in Table 2.
Not all patient s suffered from the same or all symptoms.
No statistically significant di fferences in the intensity of
symptoms was obse rved at baseline.
Table 3 presents the outcome me asures for both the
reflexolog y and the control groups before and after the
intervention. Statistically significant improvement for
each eva luated outcome measure was demonstrated in
the reflexology group, while none of them appeared to be
significant in the control group. Comparison of the out-
come mea sures between the two groups (reflexology and
control) demonstrated statistically significant differences
for scores of paresthesias, urinary symptoms and spasti-
city, while muscle strength revealed only borderline
improvement (P
The differences from baseline of both groups were
compared over time: beginning of the study, after six
weeks of treatment, end of treatment, and after additional
three months of follow-up (Table 4). The improvement in
the intensity of paresthe sia remained significant at three
months of follow-up (P
An attempt was made to locate the dropouts and invit e
them for the follow-up. However, the patients refused to
do so.
All patients (in both the study and control groups)
received physiotherapy prior to the trial and continued to
do so throughout the follow-up period.
During the treatment and the follow-up period no
changes in medication or physiotherapy wer e recorded,
except for the patients who developed an acute attack of
the disease or infectious diseases and thus were excluded
from the study.
In the present randomized controlled trial we have
demonstrated significant decreases in intensity and dura-
tion of paresthesia and of urinary symptoms as well as a
significant improvement in spasticity, and an improve-
ment of borderline significance in muscle strength in the
reflexolog y group by the end of the treatment period. No
improvement could be observed in the control group. The
improvement in both spas ticity and in muscle strength is
quite remarkable, as some of the pharmacologi cal ag ents
for treatment of spasticity are associated with muscle
Critics of complementary therapies often present the
argument that placebo effects comprise most of their
therapeutic effect, partly due to patient’s expectations,
the compas sion of the therapist and to the relaxing
atmosphere of private clinics.
In order to overcome
this obstac le, we performed all treatments in the f acility
of a hospital clinic. A design of control treatment has been
also given a careful consideration. We c onsidered the
difficulty presented to reflexologists to avoid touching
specific points of the feet. Therefore, a nonspecific
massage of the calf (rather than of the feet area) was
chosen as sham therapy, providing control for touch
therapy and general relaxation. Anot her point in evalua-
tion of trials of c omplementary therapies is related to the
fact that the skills of the prac titioners are not uniform and
thus positive results might not be reproducible. This point
was addr essed in this study by enrolling 36 reflexologists
that provided both verum and control tre atment under
supervision of two experienced reflexologists.
Table 1 Demographic characteristics of the patients
Variable Reflexology (n ¾/27)
Control (n¾/26)
Sex (female/m ale) 17/10 17/9
Age 46.29/9.3 49.29/11.0
Duration of the disease 11.99/9.2 13.49/9.1
Intention to treat 36 35
Completed the trial 27 (75.0%) 26 (74.3%)
Reasons for discontinuation:
Acute attack 3 (8.3%) 3 (8.6%)
Hospitalization unrelated to MS 1 (2.8%) 1 (3.0%)
enience of time table 3 (8.3%) 2 (5.7%)
Transportation difficulties 2 (5.6%) 3 (8.6%)
The data presents demographic characteristics of the patients within the two groups after randomization procedure (in tention-to-treat
and completers): age, sex, dura tion of the disease, the initial se
erity of the e
aluated symptoms and the reasons for discontinuation of
Reflexology in treatment of multiple sclerosis
I Siev-Ner et al.
Multiple Sclerosis
An additional difficulty inherent to such study pertains
to the treatment modality: reflexol ogy similarly to other
complementary therapies, tre ats patients on individual
basis and not according to medical diagnosis. Evaluation
of the effect of massaging of fixed points on the fe et is
therefore not always relevant or possible. For that reas on,
we evaluated the effect of reflexology (as an intervention
procedure) on outcome measures rather than investigating
the effect of specific pressure points on the feet.
Previously reported study that examined the effect of
reflexolog y on MS, demonstra ted positive results (sub-
jective clinical improvement in 45% of the patients),
though contained several methodological fla ws such as:
i) no randomization was performed to treatment and
control groups; ii) the control group receive d no interven-
tion at all.
Another randomized study that tested t he effect of
reflexolog y treatment in women who underwent an
abdominal operation, demonstrated positive e ffect of foot
reflexolog y on voiding during post-operative period.
The effect of neural therapy (a form of acupuncture) was
also evaluated in MS patients in a randomized controlled
study, which demonstrated short and long-term beneficial
effects on functional assessments of the patients.
The mechanism by which reflexology (or acupuncture)
may affect sensory, motor and urinary symptoms in MS in
not fully understood. A study that tested the hypothesis
whether reflexology is associated with specific target
organs, demonst rated that massaging the kidney area
was f ollowed by a n increase of kidney blood perfusi on.
It is also possible that similarly to the effect of acupunc-
reflexolog y may influence the release of endogen-
ous opiates that have important role in reduction of pain
and reg ulation of immune functions.
Both of these
techniques are based on traditional Chinese philosophy of
healing. While acupuncturist uses specific points along
body meridians, reflexologist applies pressure upon end
points of these meridians on the feet.
Although the effect of stress on the immune system is
well acknowledged,
patients in both groups reported
that the treatment was pleasant and relaxing, and that they
would recommend it to other patients.
A search for new treatment modalities aimed to improve
disturbing symptoms in MS continues. It is of interest to
Table 2 Characteriza tion of symptoms at ba seline
Symptom Study Group (n¾/27) Controls (n ¾/26)
Number of patients Intensity of symptoms Number of patients Intensity of symptoms
Paresthesia 23 5.629/1.5 20 4.729/2.2
Urinary symptoms 21 4.079/6.4 18 16.259/7.6
Muscle strength 27 15.339/5.4 26 13.779/5.2
Spasticity 11 5.099/4.5 16 3.259/2.1
The data represents distribution and characterization of symptoms at baseline, since not all patie nts suffered from the same symptoms.
Table 3 Comparison of outcome measures at entry and upon completion of the study in p atients treated with reexology and non-
specic massage (control)
Outcome measures Reflexology P* Control P* P**
I. Inte nsity of paresthesia (mean9/SD)
No. of patients 23 20
Before treatment 5.629/1.5 4.719/2.2
Post trea tment 4.129/2.3 4.889/2.2
Mean difference ¼/1.499/2.1 0.002 0.169/2.1 0.736 0.01
II. Urina ry symptoms (mean9/SD)
No. of patients 21 18
Before treatment 14.079/6.4 16.259/7.6
Post trea tment 9.909/4.9 16.089/8.5
Mean difference ¼/4.179/6.32 0.013 ¼/0.349/4.43 0.697 0.03
III. Mu scle strength (mean9/SD)
No. of patients 27 26
Before treatment 15.339/5.4 13.779/5.2
Post trea tment 16.239/5.2 13.999/5.9
Mean difference 0.969/1.3 0.002 ¼/0.39/1.7 0.646 0.06
IV. Spasticity (mean9/SD)
No. of patients 11 16
Before treatment 5.099/4.5 3.259/2.1
Post trea tment 3.009/4.2 3.409/2.2
Mean difference ¼/2.099/3.01 0.044 0.29/1.72 0.726 0.03
No. of patients in each group of symptoms indicate the number of patients who presented with particular symptoms.
P * Two related samples Wilcoxon Signed Ranks test.
P ** Mann¡/Whitney U-test for two independent samples.
Reflexology in treatment of multiple sclerosis
I Siev-Ner et al.
Multiple Sclerosis
note such positive effect of singl e intervention on a broad
range of symptoms. This may possibly stem from the
holistic approach of the reflexology (similarly to other
complementary therapies), that treats the whole person
rather than specific symptoms.
To the best of our knowledge, this is the first rando-
mized controlled s tudy of reflexology treatment i n MS
patients. We conclude that the treatment was safe, as the
patients reported no adverse effects. Moreover, reflexology
positively affected muscle strength and tonus and also
reduced sens ory and urinary symptoms.
Further clinical and laboratory s tudies are needed to
validate these results and to understand the mechanisms
by which reflexology improves symptoms secondary to
A ckno wledgements
Authors are gra teful to Mrs. D. Sha’ked for designing and
supervising of reexolgy treatment; to Mrs. D. Nitzani for
evaluation of musc le tone and muscle strength and to Mr.
S. Zaidel for recruitment of graduate reexologists from
the School of Human Ecology, who participated in this
study, and for his assista nce in supervising the treatment
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Table 4 Trends o
er time-differences from baseline at six weeks after the commencement of the trial, at the end of the trial and at three
months of follow-up
Study Control P-Value*
I. Intensity of paresthesias
Baseline 5.429/1.3 4.719/2.2 NS
Mean difference after 6w ¼/1.259/1.8 0.29/1.8 0.04
Mean difference at completion ¼/1.499/1.6 0.169/2.1 0.01
Mean difference at follow-up ¼/1.259/1.3 0.239/2.3 0.04
II. Urinary symptoms
Baseline 14.079/6.4 16.259/7.6 NS
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Mean difference at completion ¼/4.179/6.32 ¼/0.349/4.43 0.03
Mean difference at follow-up ¼/2.779/6.94 ¼/0.919/4.87 0.21
III. Muscle strength
Baseline 15.339/5.4 13.779/5.2 NS
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Mean difference at completion 0.969/1.3 ¼/0.39/1.7 0.06
Mean difference at follow-up 0.489/1.3 0.239/1.3 NS
IV. Spasticity
Baseline 5.099/4.5 3.259/2.1 NS
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Mean difference at completion ¼/2.099/3.01 0.29/1.72 0.03
Mean difference at follow-up ¼/1.679/3.2 0.159/2.03 0.06
NS ¾/non significant.
P -
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Multiple Sclerosis
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Reflexology in treatment of multiple sclerosis
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Multiple Sclerosis
... A total of 647 participants (86.7% women) are in the reviewed studies with a sample size range of 15 (16) to 80 (23) and an age range of 18 À 75 years. Included RCTs were classified as a single-blind randomized clinical trial (two studies with fair quality) [23,24], a single-blind randomized placebo-controlled trial (one study with good quality) [25], a randomized sham-controlled clinical trial (one study with good quality) [26], a double-blind sham-controlled clinical trial (three articles with good quality) [27][28][29], a clinical controlled trial (one study with fair quality) [30], a randomized clinical trial (two studies with good [31] and fair [32] quality), a practical trial (one study with fair quality) [16], and a controlled pilot study (one study with good quality) [17]. The general characteristics of the included studies are shown in Table 1. ...
... The included studies used different types of massage intervention approaches, including Swedish massage [17], foot reflexology [23][24][25][26][27][28][29]31], and non-specific therapeutic massage (techniques for feet, hand, back, and neck massage or effleurage, petrissage, stroking, frictions, vibrations, tapotement, rocking, and shaking) [16,30,32]. ...
... The average duration of the massage programs was 6.083 ± 2.53 weeks. The shortest intervention period lasted four weeks in foot reflexology [23,24,28,31] and therapeutic massage [32], and the longest 11 weeks for reflexology [26]. The average duration of each session was 35.68 ± 8.033 min (varied between 20 min for a therapeutic massage program [32] and one hour for reflexology [25]. ...
Purpose Multiple sclerosis (MS) causes a range of different symptoms. Patients with MS (PwMS) have looked for alternative therapies to control their MS progress and treat their symptoms. Non-invasive therapeutic approaches such as massage can have benefits to mitigate some of these symptoms. However, there is no rigorous review of massage effectiveness for PwMS. The present systematic review aims to examine the effectiveness of different massage approaches on common MS symptoms, including fatigue, pain, anxiety, depression, and spasticity. Materials and Methods A systematic search of related trials was conducted in electronic databases including Cochrane Library, PubMed, Scopus, Web of Science, and Google Scholar, using search terms related to Multiple Sclerosis and massage therapy. The PEDro scale was used to evaluate the methodological quality of reviewed studies. Results A total of 12 studies met the inclusion criteria. We rated 5 studies as fair and 7 studies as good. Fatigue was improved by different massage styles, such as reflexology, nonspecific therapeutic massage, and Swedish massage. Pain, anxiety, and depression were effectively improved by reflexology techniques. Spasticity was reduced by Swedish massage and reflexology techniques. Conclusions Different massage approaches effectively improved MS symptoms such as fatigue, pain, anxiety, depression, and spasticity. • Implications for rehabilitation • The present review results indicate that massage may have beneficial effects on motor and non-motor symptoms in MS. • Massage could be considered a complementary and alternative treatment combined with conventional medicine in people with MS. • Pain and fatigue are best improved by Swedish massage, while anxiety and depression are effectively improved by reflexology.
... Más concretamente, las indicaciones clínicas en las que se ha evaluado a la reflexología podal, mediante ensayos clínicos de calidad variable, son numerosas y heterogéneas. Entre ellas se incluyen el tratamiento de: estrés postoperatorio [14,15], cefaleas [16], asma [13,14], síndrome premenstrual [15], anovulación [16], hiperactividad del detrusor [8], diabetes tipo 2 [5], ictus cerebral [17,18], pacientes oncológicos en cuidados paliativos [5,6,11,19,20]; esclerosis múltiple [21][22][23], lumbalgia [24,25], síndrome del colon irritable [26], edema maleolar [27], síntomas menopáusicos [28] y demencia [29]. Por otro lado, algunos autores han alertado sobre el riesgo de tratar con reflexoterapia a pacientes afectados por enfermedades graves [30]. ...
... En uno de los 3 ECA en pacientes con esclerosis múltiple, Siev-Ner et al. [21], observaron una disminución de la intensidad de las parestesias (p=0,01) y una mejora de síntomas urinarios (p=0,03) y espasticidad (p=0,03). Por su parte, Gozuyesil et al. ...
... Although reflexology is not an effective intervention for any medical condition, 46 The findings of Other interventional studies confirmed reflexology is safe and without adverse effects 47 and can relieve MS symptoms such as pain 6,39,43 and fatigue. 40 Reflexology may affect the release of endogenous opiates that cause in the reduction of pain 47 and decrease of fatigue. ...
... Although reflexology is not an effective intervention for any medical condition, 46 The findings of Other interventional studies confirmed reflexology is safe and without adverse effects 47 and can relieve MS symptoms such as pain 6,39,43 and fatigue. 40 Reflexology may affect the release of endogenous opiates that cause in the reduction of pain 47 and decrease of fatigue. Because Fatigue, reduced QOL, depression, and anxiety are strongly correlated with the presence of pain. ...
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Background Fatigue and pain are prevalent symptoms of multiple sclerosis (MS) and frequent complaint in MS patients, which reduce their quality of life. This study aimed to assess the effect of massage therapy on pain and fatigue in MS Patients. Method The original and Persian databases were searched included PubMed, web of science, embase, ovid, scopus, and the Cochrane Library, SID, and Iranedex from inception to November 2020. Studies that reported the effect of massage on fatigue and pain were included. Two investigators extracted all relevant data, independently. For deriving analysis, mean difference (MD) and standardized mean difference (SMD) were used. Result Ten studies were eligible acoording criteria. The effect of massage on fatigue showed significant improvement (−1.62; 95% CL −2.40, −0.83; p < .00001), also results of the systematic review showed a significant reduction in pain severity. Conclusion Massage as a complementary and non-pharmacological therapy might have been associated with alleviating fatigue and pain in M.S. patients. Based on the current study, massage intervention for MS patients could have possible clinical value for palliating pain and fatigue and improving quality of life; however, this matter needs further and more significant trial studies.
... The usefulness of reflexology in bladder control has been identified in other research [83] leading to speculation that the mechanism of action in this case may be related to the activation of these ion channels and mechanical force being converted into initiation of the nervous system. ...
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Reflexology is a complementary therapy focusing mainly on the application of pressure on the feet, hands and ears. A small but growing evidence base suggests that positive outcomes can be gained in the management and improvement of symptoms across a range of conditions. Biological plausibility is a key concept in the determination of the usefulness of therapies. Research which tests for safety and efficacy alongside the underpinning mechanism of action are therefore important. This paper explores the potential mechanism of action for the outcomes associated with reflexology treatment as reflected in the current evidence. The influences of therapeutic touch, relaxation, placebo effects and the similarities with other therapeutic methods of structural manipulation are considered. The lack of clarity around the precise definition of reflexology and the challenges of researching the therapy as a treatment tailored to individual need are discussed. A deeper understanding of the mechanism of action for reflexology may help to further develop research into safety and efficacy. Such an understanding may lead to the integration of knowledge which may provide both symptomatic support and longer term preventative health benefits.
... Examples include osteopathy, chiropractic, massage therapy, acupuncture, and energy medicine (Fauver, 2021). Reflexology improves spasticity and urinary symptoms in patients diagnosed with MS, but the improvements are not sustained (Siev-Ner, 2003). Chinese acupuncture for progressive MS shows more improvement "inserting acupuncture needles just through the skin and away from true acupuncture sites" (p. ...
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Conventional medicine's current understanding of MS pathology raises more questions about the disease than provides answers. This paper aims to increase the understanding of disease etiology and design an effective intervention based on an increased understanding of causal factors. To do so, it will (1) provide a sample case focusing on the patient's biological, psychological, and social history to illuminate possible causative factors; (2) review medical models beyond the current convention biomedical model to expand our understanding of possible MS etiology; (3) introduce a new treatment protocol that works top-down, addressing first causal factors and lastly the resulting physical and mental symptoms; and (4) recommend particular therapies for each level of the protocol. These therapies will be specific to the sample case, considering culture, preferences, and regional availability of these therapies.
... Siev-Ner et al. believed that reflexology is useful in alleviating motor, sensory, and urinary symptoms [29]. In addition, Joyce and Richardson demonstrated a 45% improvement in symptoms associated with MS, including pain, spasm, fatigue, and depression [30]. ...
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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
... A study of Siev-Ner et al. showed that reflexology can be useful in the treatment of urinary symptoms in patients with multiple sclerosis. [16] Although in the study of Mak et al., reflexology did not affect the treatment of urinary symptoms of multiple sclerosis. [17] Reflexology causes deep relaxation of the muscles and stimulates the free circulation of blood and lymph into cells and tissues. ...
Background: During the immediate post delivery period, women are particularly susceptible to distension of the bladder. Complementary and alternative medicine is becoming an established intervention modality within the contemporary health care system. However, very little is known about the impact of foot reflexology on the urinary system. The aim of this study was to evaluate the effect of the most popular type of complementary therapy (the foot reflexology) on first voiding time following elective cesarean section without urinary catheter. Methods: This experimental study was performed on 61 pregnant women in Pastor Hospital, Mashhad, Iran, who met the inclusion criteria. Accordingly, participants were randomly allotted to either treatment or control groups. The intervention group received a single 20-min foot re?exology session at 2-3 h after the surgery. The time taken for first void was recorded by research assistant that blinded to the allocation of groups. The findings were recorded and analyzed with the SPSS software by using of Chi-square, independent t-test, Mann-Whitney, and Fisher exact methods P < 0.05 was considered as statistically significant. Results: Using General Linear Model (GLM) for controlling of confounding variables, the results of t-test showed significant differences between two groups in terms of first voiding time (P = 0.001) following surgery. Conclusion: It seems that the use of foot reflexology as a nursing care plan to prevent urinary retention after cesarean section without urinary catheter does shorten first voiding time and increase maternal satisfaction.
Many neurodegenerative conditions are chronic disorders and result in a range of debilitating symptoms, with many people turning to complementary therapies. A systematic review and meta-analysis were conducted to investigate the evidence on effectiveness of aromatherapy and reflexology on all neurodegenerative conditions. We identified nine eligible studies (total sample n = 504 participants) all of which were on multiple sclerosis only. A meta-analysis was conducted including data from six studies, which demonstrated no significant benefit of aromatherapy/reflexology; however, the sample sizes were small and of low quality. This systematic review confirmed that it is not possible to draw conclusions regarding the effectiveness of reflexology and aromatherapy in multiple sclerosis. Larger high-quality studies are required to test these widely used therapies.
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Introduction and aim: Multiple Sclerosis (MS) is a disease determined by inflammatory demyelination and neurodegeneration in the Central Nervous System (CNS). Despite the extensive utilization of Complementary and Alternative Medicine (CAM) in MS, there is a need to have comprehensive evidence regarding their application in the management of MS symptoms. This manuscript is a Systematic Literature Review and classification (SLR) of CAM therapies for the management of MS symptoms based on the International Classification of Functioning Disability and Health (ICF) model. Method: Studies published between 1990 and 2020 IN PubMed, Science Direct, Scopus, Pro-Quest, and Google Scholar using CAM therapies for the management of MS symptoms were analyzed. Results: Thirty-one papers on the subject were analyzed and classified. The findings of this review clearly show that mindfulness, yoga, and reflexology were frequently used for managing MS symptoms. Moreover, most of the papers used mindfulness and yoga as a CAM therapy for the management of MS symptoms, which mostly devoted to mental functions such as fatigue, depression, cognition, neuromuscular functions such as gait, muscle strength, and spasticity, and sensory function such as balance, in addition to, reflexology is vastly used to management of mental functions of MS patients. Conclusion: Evidence suggested that CAM therapies in patients with MS have the potential to target and enhancement numerous elements outlined in the ICF model. Although the use of CAM therapies in MS symptom management is promising, there is a need for strict clinical trials. Future research direction should concentrate on methodologically powerful studies to find out the potential efficacy of CAM intervention.
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Using colour Doppler sonography blood flow changes of the right kidney during foot reflexology were determined in a placebo-controlled, double-blind, randomised study. 32 healthy young adults (17 women, 15 men) were randomly assigned to the verum or placebo group. The verum group received foot reflexology at zones corresponding to the right kidney, the placebo group was treated on other foot zones. Before, during and after foot reflexology the blood flow of three vessels of the right kidney was measured using colour Doppler sonography. Systolic peak velocity and end diastolic peak velocity were measured in cm/s, and the resistive index, a parameter of the vascular resistance, was calculated. The resistive index in the verum group showed a highly significant decrease (p ≤ 0.001) during and an increase (p = 0.001) after foot reflexology. There was no difference between men and women and no difference between smokers and non-smokers. Verum and placebo group significantly differed concerning alterations of the resistive index both between the measuring points before versus during foot reflexology (p = 0.002) and those during versus after foot reflexology (p = 0.031). The significant decrease of the resistive index during foot reflexology in the verum group indicates a decrease of flow resistance in renal vessels and an increase of renal blood flow. These findings support the hypothesis that organ-associated foot reflexology is effective in changing renal blood flow during therapy.
A growing amount of evidence suggests that a disturbance of immunological function is of importance in the pathogenesis of multiple sclerosis. This is reflected in the drugs used to slow progression and to treat relapses. Immunosuppressive drugs such as azathioprine, cyclophosphamide and cyclosporin might have some potential to slow down progression of multiple sclerosis, but their use is limited by potentially serious adverse effects. Recently, it was shown that interferon-β-1b can diminish the exacerbation rate in multiple sclerosis without leading to unacceptable adverse effects. Nevertheless, symptomatic treatment remains of crucial importance in the management of multiple sclerosis patients. Spasticity, depression, fatigue and urinary, paroxysmal and sensory symptoms can all be alleviated to some extent with pharmacological interventions, although rehabilitation procedures and psychosocial consultations are no less important. Further therapeutic approaches to multiple sclerosis will be directed at either the specificity of the immune response or the grade of activation of the immune response. Magnetic resonance imaging techniques will play an important role in the evaluation of efficacy of new therapeutic agents.
Stress, distress and a variety of psychiatric illnesses, notably the affective disorders, are increasingly reported to be associated with immunosuppression. The concept that psychic distress may predispose to medical illness is centuries old but has only recently attracted the attention of the scientific community at large. Interdisciplinary collaboration has established psychoneuroimmunology, or neuroimmunomodulation, as a new field of investigation with the goal of rigorous scientific research into the elusive mind-body connection. This has resulted in the rapid accumulation of information which falls across the boundary lines of psychiatry, immunology, neurosciences and endocrinology. Here David Khansari, Anthony Murgo and Robert Faith review the effects of stress on the endocrine and central nervous systems and the interactions between these systems and the immune response after exposure to stress signals.
This article has no abstract; the first 100 words appear below. SPASTICITY has been defined in strictly physiologic terms as "a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes ('muscle tone') with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome." ¹ Whereas this definition refers to the minimum positive symptom in patients with "spasticity," it does not refer at all to the other components of the upper-motor-neuron syndrome² that are usually most troubling to patients. These components include positive symptoms, such as flexor spasms, and a multitude of negative symptoms designated somewhat inadequately as weakness and loss of . . . We are indebted to Paul G. Andriesse, medical illustrator, for his excellent artwork. Source Information From the Movement Disorder Clinic and Clinical Neurophysiology Laboratory, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, and Neurologie-Neurophysiologie Clinique, Département de Clinique et de pathologic Médicales, Institut de Médecine, Hôpital de Baviére and Université de Liège, Belgium. Address reprint requests to Dr. Young at the Clinical Neurophysiology Laboratory, Massachusetts General Hospital, Boston, MA 02114.
About 45 essential nutrients are needed for health maintenance, and among them are some 15 minerals or metals.1 Many of these minerals are required in small amounts in normal diets, but their specific role in human health is still a matter for exploration. A trace element of current interest is selenium, whose role in the nutrition of various animal species is now well established. A dietary deficiency of selenium causes muscular dystrophy in ruminants (sheep and cattle), pancreatic degeneration and exudative diathesis in poultry, and liver necrosis in rats.2 Indeed, recognition of the importance of selenium in poultry nutrition has . . .
To investigate whether there is a significant placebo component to the improvements seen after 1-session transurethral microwave treatment, 40 patients with significant symptoms of prostatism and unequivocally benign glands were recruited to take part in a sham controlled study. After an active treatment the mean American Urological Association symptom scores improved by 63% (19.2 to 7.1) while after a sham treatment symptom scores improved only marginally (18.8 to 16.2, p < 0.001). Residual volumes decreased by 50% (104 to 52 ml.) and flow rates increased by 2.3 ml. per second after an active treatment with no improvement after a sham treatment. There was a consistently greater improvement after an active treatment compared to a sham treatment. Patients who had received a sham treatment were then offered an active treatment and showed improvements similar to those in the original actively treated group and much greater than after the original sham treatment. Mean symptom scores decreased from 16.2 to 9.9 (p < 0.004). Residual volumes decreased from 94 to 40 ml. (p < 0.005) and flow rates increased by 1.6 ml. per second, while these same criteria had deteriorated after a sham treatment. Side effects were mild and short lived, with no patients reporting sexual dysfunction as a consequence of treatment. Transurethral microwave therapy is an effective well tolerated treatment for select patients with benign prostatic hypertrophy and the placebo effect of treatment is minimal.
A growing amount of evidence suggests that a disturbance of immunological function is of importance in the pathogenesis of multiple sclerosis. This is reflected in the drugs used to slow progression and to treat relapses. Immunosuppressive drugs such as azathioprine, cyclophosphamide and cyclosporin might have some potential to slow down progression of multiple sclerosis, but their use is limited by potentially serious adverse effects. Recently, it was shown that interferon-beta-1b can diminish the exacerbation rate in multiple sclerosis without leading to unacceptable adverse effects. Nevertheless, symptomatic treatment remains of crucial importance in the management of multiple sclerosis patients. Spasticity, depression, fatigue and urinary, paroxysmal and sensory symptoms can all be alleviated to some extent with pharmacological interventions, although rehabilitation procedures and psychosocial consultations are no less important. Further therapeutic approaches to multiple sclerosis will be directed at either the specificity of the immune response or the grade of activation of the immune response. Magnetic resonance imaging techniques will play an important role in the evaluation of efficacy of new therapeutic agents.
Acupuncture is part of Traditional Chinese Medicine, a system with an empirical basis which has been used in the treatment and prevention of disease for centuries. A lack of scientific studies to prove or disprove its claimed effects led to rejection by many of the western scientific community. Now that the mechanisms can be partly explained in terms of endogenous pain inhibitory systems, the integration of acupuncture with conventional medicine may be possible. Its use for pain relief has been supported by clinical trials and this has facilitated its acceptance in pain clinics in most countries. Acupuncture effects must devolve from physiological and/or psychological mechanisms with biological foundations, and needle stimulation could represent the artificial activation of systems obtained by natural biological effects in functional situations. Acupuncture and some other forms of sensory stimulation elicit similar effects in man and other mammals, suggesting that they bring about fundamental physiological changes. Acupuncture excites receptors or nerve fibres in the stimulated tissue which are also physiologically activated by strong muscle contractions and the effects on certain organ functions are similar to those obtained by protracted exercise. Both exercise and acupuncture produce rhythmic discharges in nerve fibres, and cause the release of endogenous opioids and oxytocin essential to the induction of functional changes in different organ systems. Beta-endorphin levels, important in pain control as well as in the regulation of blood pressure and body temperature, have been observed to rise in the brain tissue of animals after both acupuncture and strong exercise. Experimental and clinical evidence suggest that acupuncture may affect the sympathetic system via mechanisms at the hypothalamic and brainstem levels, and that the hypothalamic beta-endorphinergic system has inhibitory effects on the vasomotorcenter, VMC. Post-stimulatory sympathetic inhibition which proceeds to a maximum after a few hours and can be sustained for more than 12 hours, has been demonstrated in both man and animals. Experimental and clinical studies suggest that afferent input in somatic nerve fibres has a significant effect on autonomic functions. Hypothetically, the physiological counterpart lies in physical exercise, and the effect can be artificially reproduced via various types of electrical or manual stimulation of certain nerve fibres.
Multiple sclerosis (MS) is a chronic progressive disease with symptoms that are often difficult to interpret and distinguish from other neurological disorders. These symptoms are discussed together with psychological interventions, physical management and occupational therapies. A review of studies is presented as well as concepts for service provision for MS patients in the NHS. Finally, current practice in an interdisciplinary rehabilitation unit is discussed, and some recent advances in MS treatment are noted.
Extensive research is under way to develop pharmacotherapeutic agents that will prevent the exacerbations and the progression of neurologic disability associated with multiple sclerosis (MS). The most intensive research strategy has involved agents intended to limit demyelination by reducing inflammation and modifying the immune response. In this category are interferon beta-1b, the first compound approved for use outside of clinical trials; interferon beta-1a; and copolymer 1. Experimental agents include other interferons, methotrexate, linomide, monoclonal antibodies, T-cell receptor peptides, and 2-chlorodeoxyadenosine. Although they have been used effectively to treat exacerbations of MS, corticosteroids and corticotropin are now under evaluation as disease-modifying agents. A second strategy, enhancing remyelination by limiting demyelination and oligodendrocyte injury, is represented by protein growth factors. A third therapeutic approach, improving conduction in demyelinated fibers, is represented by the potassium channel blockers 4-aminopyridine and 3,4-diaminopyridine.